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Last moment revisions in Anatomy

Dr. Sreeja. S MD(Hom) Scholar


Govt. Homoeopathic Medical College. Calicut. Kerala
Email : sreejaspai81@yahoo.co.in

Study of the microscopic structure of the human organism


co related with the development, function and clinical
significance.
It is derived from Greek term anatome
meaning cutting apart.

EMBRYOLOGY
It is the study of the formation and development of the
embryo from the moment of its inception upto
the time when it is born as an infant.
Gonads: no: of chromosomes in an
organism=23 pairs/46 no.
-----44 autosomes XY
----44 autosomes - XX
Karyotyping : Classification of chromosomes
based upon their differences that enable us to
identify each chromosome individually.
Spermatogenisis : The process of formation
and development of spermatazoan .
Formed in the wall of the
seminiferous tubules of testes.
Spermiogenesis (spermateleosis) : The
process of transformation of a circular
spermatid to a spermatozoan.
Mature spermatozoan: Has a head, a neck middle piece
and a principal piece or tail. Head is covered with a cap
called acrosome.
Length -50-60 microns
Golgi apparatus forms the acrosomic cap.
Nucleus forms head.
Mitochondrion forms the sheath of middle
piece.
Proximal centriole comes to lie in the neck.
Distal centriole becomes ring shaped and forms
the annulus.
Axial filament grows out from the centriole and
is present in middle piece and tail.
Viability of spermatozoa =4 days.

Ovulation: The shedding of ovum from the


ovary.
Corpus luteum- It is an important structure
derived after the rupture of ovarian follicle to
shed the ovum.
It secretes hormone progesterone.
Viability of ovum =24 hrs
Menstrual cycle: Divided into 4 phases
1.Post menstrual phase
2.Proliferative
3.Secretory(premenstrual)
4.Menstrual
Follicular phase ---post menstrual +
proliferate phase -~ Oestrogen
Luteal phase secretory +menstrual phase
-~ progesterone
Size of Oocyte 120u.
Approximate number of occytes at puberty
around 40,000.
Approximate number of ova liberated during
reproductive period of femalearound 300 to
400.
Time required for formation of spermatozoa
from spermatogonium64 days.
Fertilized ovum reaches uterine cavityby 4
days.
Implantation of ovum (fertilized) occursabout
7th day.
Primitive uteroplacental circulation beginsby
end of 2nd week.
Number of somites in embryo 42 to 44.
Time of somite formation 21 to 30th day.
Organogenesis from 4th to 8th weeks.
Formation of primary ovary in a female takes
place by 8th week

Differentiation of genital organs


1.Persons with two X chromosomes are
female; those with one x and one y are male.
2.Y chromosome bears a gene responsible for
production of a testis determining factor.
3.Interstitial cells in testis produce testosterone .It forms
a complex with certain receptor proteins which attaches
itself
to DNA. This causes the mesonephric duct to develop as
in male.
4.Presence of dihydrotestosterone .
5.Sertoli cells produce mullerian inhibiting
substance .This causes regression of
paramesonephric ducts.
Genital swellings in male differentiate into
scrotum whereas in a female, they form labia
majora.
The mesonephric duct in a female develops
into Gartner's duct.
The Mullerian ducts in male develop into appendix testes
whereas in a female, they develop into uterus and uterine
tubes.
In female, the homologue of prostatic glands
are paraurethral glands.

FOETAL CIRCULATION
Differs from adult circulation in
a) Source of oxygenated blood is not the lung
but the placenta.
b) Oxygenated blood from placenta comes to
foetus through umbilical vein and joins the left
branch of portal vein.
Small portion passes through the substance of
the liver to I V, but the greater part passes
direct to I V through the ductus venosus.

Changes at birth: 1) umbilical artery contracts.


2) Lumen of umbilical veins and ductus
venosus occludes and this takes place a few
minutes after birth.
3) Ductus arteriosus occludes by about 10 th
day.
4) Pulmonary vessels increase in size.left atrial pressure
rises than that of right atrium and leads to closure of
foramen ovale.
Remnant of
Umbilical artery - medial umbilical ligament
Left umbilical vein - ligament teres of the liver
Ductus venosus - Ligamentum venosum
Ductus arteriosus - Ligamentum arteriosum

OSTEOLOGY
Study of bones.
Bones are divided according to their
1)Position
Human skeleton -------axial} bones of skull,
vertebral column, ribs, sternum, hyoid.
-------appendicular} bones of
pectoral, pelvic girdle ,upper and lower limbs
2) Shape
Long bones: eg: Femur, tibia, humerus, ulna,
radius, and fibula
Short long bones: eg: Metacarpals,
metatarsals, phalanges
Short bones: eg: Carpals, tarsals
Flat bones: eg : Scapula , sternum, ribs,
parietal and frontal.
Pneumatic bones : Maxillary ,sphenoid ,
ethmoid, mastoid part of temporal bone.
Irregular bones: eg: Vertebrae, skull bones
Sesamoid bone: eg: patella, pisciform, fabella

2)Structure
Compact bone =consisting of haversian system
Cancellous (spongy) bone = consisting of
irregularly placed lamellae.
Diploic =consisting of inner and outer tables of
compact bone with intervening porous layer.

3)Development
Ecto chondral bones: which develop in
membrane (membranous)
Endochondral bones: which develop in
cartilage. (cartilageneous)

Total no of bones ---206


Upper limbs-64
Lower limbs-62
Vertebrae-33
Skull - 29(14-facial bones
- 14- cranial bones , hyoid
bone )
Sternum-1
Ribs- 12 pairs
Longest bone---femur
Smallest bone---stapes
Strongest part in human body- Enamel of teeth
Largest sesamoid bone --- Patella developing
in quadriceps.
Microscopic unit of a bone: Haversian system
(secondary osteone)

Ossification
Process of gradual bone formation.
a)Ossification in membrane (direct)easy
process
Eg: clavicle, bones of face,vault of skull.
b)Ossification in cartilage (Indirect) ---gradual
process.
Eg: bones of limbs, trunk.
Secondary cartilage bone: eg: neck of
mandible, sternal end of clavicle.
Primary centres of ossification may be single or multiple
,appear before birth between 6th 8th week of foetal life
except cuneiform ,navicular bones .
Secondary centres of ossification are multiple
and appear after birth except lower end of
femur.
Ossification of acetabulum is complete at 16-
17 years
Growing ends of bones of upper limbupper end of
humerus & Lower end of radius and
ulna
Growing ends of bones of lower limbs ----
lower end of femur & Upper limbs of tibia and
fibula
In long bones, growing ends fuse with shaft at
20 yrs and opposite ends at about 18 yrs.
In other bones it is between 20-25 yrs.

Types of epiphysis are :


a) Pressure epiphyses - located at pressure
points like joints
b) Traction epiphyses: subjected to traction by
pull of muscles when located at the muscular
attachment
c) Atavistic epiphyses: centre appearing in the
part of bone which was orginally a separate
bone in evolution eg : Coracoid
process of scapula.
Hyaline cartilage has a tendency to get
calcified in later years of life.
Skull bones22 bones
Facial bones (14)-paired-nasal, maxillae,
zygomatic, palantine, lachrymal, inferior nasal
connchae.
Unpaired-mandible,
vomer
Cranial bones (14)-paired- parietal, temporal,
ear ossicles
Unpaired- frontal,
ethmoid, sphenoid, occipital.

Carpal bones- 8 bones Lat TO medial


(Proximal) Scaphoid, lunate, triquetral,
pisiform
(Distal)Trapezium, trapezoid,
capitate, hamate.
Tarsal bones-7 bones (proximal) Talus,
calcaneus
(distal) medial cuneiform, intermediate
cuneiform, lateral cuneiform, cuboid.
Largest and strongest of tarsal bones
Calcaneus

Paranasal sinuses 4 pairs : Frontal,


sphenoidal, ethmoidal, maxillary.
Largest of all air sinuses ---Maxillary sinus
(Antrum of Highmore)

Foramina of skull
Anterior cranial fossa :
1.Foramen caecum: lies between the alae of
crista galli of ethmoid and frontal crest.
Transmits an emissary vein.

Middle cranial fossa:


2.Optic canal (foramen): Transmits optic nerve,
opthalmic artery.
3.Superior orbital fissure: Bounded by lesser
wing above, greater wing below and body of
sphenoid medially.
Divided by three compartments by common
tendinous ring.
Transmits superior and inferior divisions of oculomotor,
nasociliary nerve, abducent nerve, trochlear nerve, frontal
nerve,
lacrimal nerve, lachrimal artery, orbital branch of middle
meningeal artery, superior ophthalmic vein,recurrent
meningeal
branch of lachrymal artery, inferior ophthalmic vein.
4.Foramen rotundum---transmits maxillary
nerve.
5. Foramen ovale --- transmits mandibular
nerve,accessory meningeal artery ,lesser superficial
petrosal nerve, emissary vein.
6. Foramen spinosum--- transmits middle
meningeal artery, nervus spinosus
7. Foramen lacerum--- transmits Internal
carotid artery.
8. Carotid canal---- transmits internal carotid
artery with plexus, emissary veins,
meningeal lymphatics.

Posterior cranial fossa:


9. Jugular foramen --- transmits 9th,, 10,
11th cranial nerves.
10. Foramen magnum---largest foramen in
skull.
Divided into anterior small
compartment: Apical ligament
Upper band of
cruciate ligament
Condylar parts
on sides.
Posterior large compartment: lower end of medulla
oblongata, 2 anterior and one posterior spinal artery, veins
joining
venous plexus, lower part of tonsil of cerebellum, vertebral
artery, sympathetic plexus, spinal root of accessory nerve.

Ribs: 12 in number on each side.


True ribs1-7th
False ribs--- 8-12th
Floating ribs --- 11-12th
Atypical ribs1, 2, and 10.11, 12th.

Folds of duramater
Falx cerebri encloses superior
sagittal sinus, inferior sagittal sinus, straight
sinus
Tentorium cerebelli- encloses
transverse sinuses, posterior petrosal sinuses.
Falx cerebelliencloses occipital
sinus
Diaphragma sellaeencloses
anterior and posterior intercavernous sinuses.

Important points in skull


1.Bregma: meeting of coronal and sagittal
sutures.site of anterior fontanelle, closes at
11/2 yrs of age.
2 .Lambda: meeting of sagittal and lambdoid
sutures .site of posterior fontanelle ,closes at
2-3 months of age.
3. Nasion : meeting point of internasal and
fronto nasal sutures.
4. Inion : centre of external occipital
protruberance.
5. Pterion : area formed by meeting of frontal, squamous
part of temporal ,parietal, greater wing of sphenoid.deep
to
this lies anterior branch of middle meningeal artery,
middle meningeal vein ,stem of the lateral sulcus.
6. Asterion : point at the postero inferior angle
of parietal bones.
Diaphragm
Inferior aperture (outlet )of thorax.
Aortic openingT12- transmits Aorta, thoracic
duct, Azygos vein
Oesophageal openingT10-transmits
oesophagus, gastric nerves, oesophageal
branches of left gastic artery.
Venecaval opening --- T8 transmits inferior
venecava, branches of right phrenic nerve.

CEREBROSPINAL FLUID
(CSF)
Definition
CSF is a modified tissue fluid in the central nervous
system. It is contained in the ventricular system of brain
and the
subarad space of brain and spinal cord. CSF replaces
lymph in the CNS. It acts as a sensitive mirror which
reflects
diseases of the na system. Formation
1.The bulk of the CSF is formed by choroid plexuses of the
lateral ventricules, and the lesser amounts by the choroid
plexus
the third and fourth ventricles. '
2.Possibly it is also formed by the capillaries on
the surface of the brain and spinal cord.

Circulation
CSF passes from the lateral ventricles to the third
ventricle through foramina of Monro (interventricular
foramina). From
ventricle it passes to the fourth ventricle through cerebral
aqueduct. From fourth ventricle the CSF passes to the
subarachnoid
around the brain and spinal cord through the foramen of
Magendie and foramina of Luschka.
Absorption
1.CSF is absorbed chiefly by the arachnoid villi and
granulations, and is thus drained to the cranial venous
sinuses.
2.It is also absorbed partly by the perineural
lymphatics around I, II, VII and VIII cranial
nerves
3.And also by the veins related to the spinal
nerves.
Rate of Formation
200 cc/hour, 5000 cc/day.
Total Quantity About 150 cc.
Pressure:60-150 mm of fluid (or water).
Composition
Proteins 20-40 mg per 100 cc.
Sugar 50-75 mg per 100 cc.
Chlorides 720-750 mg per 100 cc.
Cells 0-5 per cubic mm

Functions
It is (a) protective, (b) nutritive, and (c)
excretory to the CNS.
Applied Anatomy
1.CSF can be obtained by (a) lumbar puncture, (b)
cisternal puncture, or (e) ventricular puncture. Lumbar
puncture is 1st
method of all and is commonly used. It is done in the
interspace between third and fourth lumbar spines.
2.Biochemical analysis of the CSF is of
diagnostic value, as the cases of meningitis
and spinal tumours.
3.Drainage of CSF at regular intervals is of therapeutic
value in meningitis. Certain intractable headaches of
unknown are
also known having been caused by a mere lumbar
puncture with drainage of CSF.
4.Obstruction to the flow of CSF in the ventricular system
of brain leads to hydrocephalus in children .Spinal
obstruction
leads to Froins syndrome.

Length of parotid duct: 5 cm.


Length of submandibular duct: 5 cm.
Length of auditory tube: 36 mm.
Bony part: 12 mm.
Cartilagenous part: 24 mm
Length of external acoustic meatus(from
bottom of choncha): 2.4 cm.
Bony part:16 mm.
Cartilagenous part:8 mm.
Transverse diameter of mid cavity
Opposite the centre of tympanic
membrane: 2 mm.

Total number of cones in the retina: 6.3 to 6.8


million.
Length of pharynx: 12 to 14 cm
Length of larynx
Length of vocal cords
Length of Trachea -
Pituitary gland: 13 x 8 mm.
Heart Measures 12 x 9 cm
(5x3 or 3.5 inches)
Weight 300 g (males)
250 g (females)
Termination of oesophagus 11th Thoracic
vertebra.

Constrictions in oesophagus :
at commencement 15 cm from incisor teeth.
at crossing over by aortic arch 22.5 cm from
incisor teeth.
at crossing over by left principal bronchus 27.5
cm from incisor teeth.
at its point of piercing diaphragm 40 cm from
incisor teeth.
Stomach :
Cardiac orifice Behind left 7th costal cartilage
1" from its junction with sternum.
Pyloric orifice 1.2 cm (0.5") to the right of
midline on transpyloric plane.
Capacity at birth 30 ml; adults 1500 ml.
Length of small intestine: 6 to7 metres
Length of duodenum: 10 or 25 cm
1 st part: 5 cm
2nd part: 7.5 cm
3rd part: 10 cm
4th part: 2.5 cm
Length of large gut: 1.5 metres
Anal canal
Hilum of kidney Transpyloric plane (LI).
Kidney:Length: 11 cm, Breadth : 6 cm,
Antero-posterior diameter: 3 cm
Length of Ureter : 25 cm
Length of male urethra: 18-20 cm
Spermatic cord : 9-10 cm
Length of inguinal canal: 4 cm
Testis: Length-4.5 cm, Breadth-2.5cm,
Anteroposterior dr-3
Ovary: Length -3 cm, Width-1.5
cm,Thickness-1 cm
Uterus: Length-7.5 cm, Breadth-5 cm,Antero-
posterior diameter-2.5 cm
Weight :30 to 40 gms
Uterine tubes: Length-10 cm
Saphenous opening Height 1.5 to 8 cm;
Width 1 to 3 cm
Femoral sheath Length 3 to 4 cm.
Femoral canal Length 1.25 cm.
Tendo calcaneus Length 15 cm.
Weight of spinal cord 30 gms.
Length of spinal cord 45 cm.
Filum terminale 20 cm.
Internum 15 cm.
Externum 5 cm.
Commencement of spinal cord Cranial
border of C1 vertebra (Atlas).
Termination of spinal cord - lower border of
LI or disc between LI & L2 vertebrae.
Cervical enlargement of spinal cord
Circumference 39 mm. Extends from LI to SI
spinal segments.
Lumbar enlargement of spinal cord
Circumference 35 mm. Extends from LI to S3
spinal segments.

Vertebral levels of spinal segments


Cervical vertebral spine corresponds to
succeeding cord segment Eg : C6 spine to C7
segment.
Upper thoracic spine corresponds to two spinal
segments lower Eg : T4 spine corresponds to
T4 spinal segments.
Lower thoracic spine corresponds to three spinal sements
below Eg : T10 spine to LI spinal segment. T11 spine to
L3segment, T12 spine to SI segment.
New born child lower limit of spinal cord is at
L3 vertebral upper border.
Length of medulla oblongata 3 cm.
Shortest segment of brain stem mid brain
2.cm.
Thalamus-Length - 4 cm.
Corpus callosum length 10 cm.
Specific gravity of C.S.F: 1007.
Pressure of CSF (in recumbent position):100 to
150 mm of H2O
Total volume of CSF in man: 140 ml; amount
of CSF in Ventricles 25 ml.
Commencement of subclavian artery Behind
sternoclavicular joint.
Termination of Subclavian artery Outer
border of 1st rib.
Termination of Brachial artery Neck of
radius.
Thoracic Aorta :
Commencement T4 Vertebral lower border.
Termination T12 Vertebral body.
Abdominal Aorta commencement T12
Vertebral body.

Coeliac Trunk:Origin T12, Length 1.25


cm.Superior mesenteric artery LI.
Inferior mesenteric artery L3.
Commencement of common iliac L4
vertebral body.
Bifurcation of common iliacSacroiliac joint
External iliac termination Mid-inguinal point.
Vertebral prominence C7.
Superior angle of scapula T2.
Upper border of manubrium sterni
(suprasternal notch)T2, T3 vertebral
junction.
Spine of scapula T3
Sternal angle T4 & T5 (Disc between).
Inferior angle of scapula T7.
Xiphisternal joint T9.
Tonsil is derived from 2nd pouch
CSF to plasma glucose ratio is normally 0.6 to
0.8
Appearance of permanent kidney 5th week
of Intrauterine period.
Invasion of primordial germ cells into
developing gonad 5th week.
Appearance of neural plate (nervous system)
3rd week.
Development of eye between 4th and 7th
weeks.
Appearance of limb buds beginning of 5th
week.

Descent of testis:
At deep inguinal ring 7th month of intra
uterine life.
In inguinal canal 8th month of intrauterine
life.
At superficial inguinal ring 9th month of
intrauterine life.

Haller's circle is found in the Pyloric orifice.


Marginal artery of Sudeck lies at 2.5-3.8 cm
from colon.
Portal vein is about 8 cm long.
The maximum breadth of mesentry is in
central part and is 8 inches
The lesser omentum is a fold of peritoneum extending
from lesser curvature of stomach and first 2 cm of
duodenum to the liver.
Common carotid artery is derived from III
aortic arch.
At full term, diameter of placenta is 6-8 inches.
Mesentry contains about 100-200 lymph
nodes.
Between lowest sigmoid and sup. Rectal artery
anastomosis is regarded as the critical point of
Sudeck.
Mesentry is fan shaped fold of peritoneum.
Total area of placenta is 14 sq. m.
Oesophagus structure is related to both left
and right lung.
Weight of parathyroid gland is 50 mg.
Length of caecum is 6 cm.
Sprain of ankle is most often due to abduction.
The superficial muscles of the back of leg are
supplied by S1,2.
Thickness of suprarenal is 10 mm.
Duodenojejunal is largest duodenal recess.
Cisterna chyli is 5-7 cm long.
Ovary has minimum thickness.
V pharyngeal arch disappears at the earliest.
Weight of prostate gland is 8 gm.
Longest part of duodenum is III.
Left dome of diaphragm corresponds to the
lowest part of 5 rib.
Width of stomach is 10-12 cm.
Claustrum is situated between putamen and Insula

Third ventricles are derived from Diencephalon.


Thickness of spleen is 3-4 cm.
Middle one third of transverse colon is derived
from midgut.
Placental membrane at its formation is 0.025
mm thick.
Syncytiotrophoblast is called
plasmoditrophoplast.
Midbrain is Mesencephalon.
The left brachiocephalic vein is about 7.5 cm
long.
Deep palmar arch is about 4 cm long.
Spine of scapula corresponds to 3rd thoracic
spine.
Pereoneal tubercle if felt as a prominence about
2.0 cm below tip of lateral malleolus.
Hip joint lies 1.2 cm vertically below the middle
third of inguinal ligament.
Pulmonary arteries are derived from VI aortic
arch.
Ischial tuberosity is felt 5.0 cm away from the
median plane.
Nelaton's line touches the centre of
acetabulum, ishcial tube and Ant. sup. iliac
spine.
Filum terminale is about 20 cm long which extends from
conus medullaris to the back of the 1st coccygeal vertebral
segment
The duramater of spinal cord ends at S2
vertebral level.
Erb's point is C4 C5.
Ureter is 50 cm long.
Distance between upper incisors and
gastroesophageal junction is 40 cm.
The ratio of weight of liver and weight in an
adult is 1: 40.
Oesophagus crosses the diaphragm at level of
T10.
Developing gonad is identified as male or
female by the end of 7th week.
The infant with pupillary membrane must have
been product of pregnancy lasting less than 7
months.
Stillborn foetus with eyelids fused is of 3-7
months.
Length of a mature human spermatozoon is 50-
60 microns.
Breast development in intrauterine life starts at
12 weeks.
Point situated 1 cm below sacral promontary
representing CG of body is Weber's point.
The number of ossification centres in the hyoid
bone is 6.
Great saphenous vein is exposed anterior to
medial malleolus at 2.5 cm.
Ossification centres for all carpal bones is found
by 5th year.
Xiphisternal junction is usually at the level of
disc between T9 and T10 verterbra.
Length of ductus deferens is usually 45 cms.
Frontal eye field motor area is 8.
Nerve supplying submandibular gland is VII
nerve.
Length of female urethra is 4 cm.
Root value of phrenic nerve is C^5.
Sacral canal's volume is 25-35 c.c.
Detrusor is supplied by Sj_4.
At midaxillary line, parietal pleura extend up to
level of 10th rib.
The weight of the left healthy lung is 570 gm
and that of right is 620 gm.
The SA node is by a branch of the right
coronary artery in 65%.
The AV node is supplied by a branch of the right
coronary artery in 80%.

Upto 80% of liver resection can be tolerated by


noncirrhotic individual.
Liver has a high power of regeneration. Following
resection of two third portion of liver, it regenerates in
about six month
Hepatocytes drain about one litre of bile daily into bile
canaliculi.
Common bile duct (CBD) is about 10 cm long.
Normal size of CBD is 6-10 mm.
Normal pressure in portal vein is 6-12 mm. of Hg.
Average size of spleen is about 5x3x1 inch. Average
weight is about 150 gm.
Average size of kidney is been shaped, having weight
about 150 gm.
Blood flow through each Kidney is 1-2 litre per
minute.
Normal capacity of UB is about 250 ml. but can
accommodate upto 500 ml of Urine.
Prostate secretes 0.5-2 ml of fluid per day, which
contains Acid Phosphatase, Prostate glandins,
Fibrinogen and Citric Acid.
Length of large intestine is'1.5 m.
Length of anal canal is 3.8 cm.
Part of anal canal about 15 mm below anal valves is
the transitional zone pectin.
Bile duct is 7.5-10 cm long.
Gall bladder has Capacity of 45 ml (range 30 to 50
ml) and length of 7.5 to 10 cm. \
Ureter lies 2 cm lateral to cervix and Uterine artery
crosses above and infront of ureter.
Size of ovary is Length 3 cm, Width 1.5 cm, Thickness
1 cm.
Vascular segments of kidney are 5.
Number of lobules in foetal kidney is 12.
Saphenous opening is a gap in fascia lata of thigh,
situated 4 cm. below and lateral to pubic tubercle. Its
sharp edge is called falciform margin.
Saphenous opening is covered by cribriform fascia.
Inter alveolar septum0.2 m thick (Arithmetic means
thickness of barrier in human is 2.2 nun).
Manubriosternal angle may be ossified after the age
of 30 years.
Cervical curve appears in intrauterine life and
accentuaies by 3 or 4 months when the child hold up
the head.
Lumbar curve appears at 12 to 18 months when the
child begins to walk.
Subpubic arch is more angular in males (50 to 60),
in females it is wide usualy 80 to 85.
Greater sciatic notch is wider in females 50.4 and
in males is 74.4.
Sacral index in males 10.5% and in females 115%.
In hip joint, extension beyond vertical is 10 to 20.
Extension of knee beyond vertical femoro-tibial axis is
5 -10 and flexion is 120 with extended hip joint.
Passive rotation in knee is about 60 to 70 but
conjuct rotation is only about 20.
In "Colles "fracture", there is a fracture of distal end
of radius with displacement of lower fragment
backwards and upward. This occurs due to fall of
outstretched hand. Resulting deformity is dinner fork
deformity.
Anal canal is 38 mm long (upper - 15 mm, middle -
15 mm, lower - 8 mm)
In hip, primary centres of ossification appear in the
order of ilium (2nd month), ischium (4th month), and
pubis .
Main action of quadrator femoris is lateral
rotation.
Foramen lacerum lies in between petrous part
of temporal bone and sphenoid.
Parotid duct pierces the buccinator muscle.
Functional tissue of lungs is alveoli.
Carpal tunnel syndrom involves median nerve
Meckel's diverticulum arises from the
antimesenteric border of ileum.
Auerback's plexus is located in oesophagus.
Brachialis is supplied by musculocutaneous as
well as radial nerve.
Gluteus maximus is supplied by inferior gluteal
nerve.
Trendelenburg sign may be positive in gluteal
medius paralysis.
Elbow is a condyloid joint
Left testicular vein drains into left renal vein.
Flexor digitorum profundus has a dual nerve
supply.
Anterior interosseus artery is a branch of ulnar
artery.
Purkinje cells in cerebellum are input cells.
The most fixed part of the GIT is duodenum.
The glands of Brunner are seen in duodenum.
Spinal part of accessory nerve supplies
sternocleidomastoid muscle.
T-s free border of lesser omentum contains
hepatic artery, portal vein and bile duct.
Lateral rectus is supplied by VI cranial nerve.
Dentate nucleus is a part of cerebellum.
Lamina cribrosa is modification of sclera.
Automatic bladder is seen in lesions of higher centres
whereas lesions at lower centres lead to autonomic
bladder.
Coronary sulcus is occupied by the coronary
sinus.
Siren or vena cava is formed by brachiocephalic
veins.
The base of heart, formed by atria, lies
opposite the 5th-9th thoracic vertebrae.
All the tongue muscles are supplied by hypoglossal nerve
except palatoglossus muscle which is supplied by
pharyngeal plexus of nerves

Tympanic membrane is derived from ecto, meso and


entoderm.
Edochondral ossification is seen in scapula.
Melanoblasts are derived from neural crest cells.
Human placenta is haemochorial.
Commonest part of aorta ruptured in trauma is
junction of thoracic and abdominal aorta.
The only pharyngeal muscle innervated by the
glossopharyngeal nerve is stylopharyngeus.
Radial bursa encloses the tendon of flexor pollicis
longus.
Choroid fissure of the eye permits the entry of hyaloid
artery.
Uncinate fasciculus connects frontal and temporal
lobes.
Musician's nerve is ulnar nerve.
Ligament of Cooper is related to breast.
Jacobson's nerve is a branch of IX nerve.
Fascia cribrosa is related to femoral canal.
Boa's point is a tender spot felt in the left of T12 in a
patient with gastric ulcer.
Buck's fascia is related to penis.
Prostoperitoneal fascia is Denonviller's fascia.
Fascial extension of lacunar ligament along
iliopectineal line is Cooper's ligament.
Alderman's nerve is a branch of X nerve.
Labourer's nerve is median nerve.
Veins communicating the cavernous sinus to
pterygoid plexus pass through fossa of Vesalli.
Duct of Rivinus is found in sublingual gland.
Foramen transversarium transmits vertebral artery.
.Krause's glands are lacrimal glands.
Hepatorenal pouch is Morrison's pouch.
.Cowper's glands are found in bulbous urethra.
Duct of Santorini is accessory pancreatic duct.
Anterior interventricular artery is branch of left
coronary artery whereas posterior one is a branch of
right coronary arti
Thinnest portion of myocardial wall is left and right
atria.
.The nerve related to medial epicondyle is ulnar .
Depressor of mandible is lateral pterygoid.
Edinger Westphal nucleus is General Visceral Efferent.
Hofbauer cells are present in placenta.
Transpyloric plane passes through L1 vertebra.
Smallest cranial nerve is Trochlear.
Charcot's artery is a branch of middle cerebral artery.
Apelike hand occurs in median nerve palsy at wrist.
Inferior tibiofibular joint is syndesmosis type of joint.
Mandibular canal contains inferior alveolar nerve.
Costocoracoid membrane of axilla is pierced by lateral
pectoral nerve.
Most stable position of the ankle joint is dorsiflexion.
General sensation of nulliparous uterus is anteversion
and anteflexion.
Highest intercostal space used for liver biopsy is 8th.
The weakest parts of inguinal canal are superficial
and deep inguinal rings.

Diaphragmatic hernia commonest on the left


is traumatic hernia.
Flexion of the knee joint takes place in the
upper compartment.
The nerve responsible for fine movements of
the hand is ulnar.
The retraction of shoulder is caused by serratus
anterior.
Accessory pancreatic duct is also called
Bernard's duct.
Thoracic duct is also called Pecquet duct.
Superficial fatty fascia between umbilicus and
pubis is Camper fascia.
Parasympathetic outflow from sacral plexus is
nerve Erigentes.
CSF is partly absorbed by lymphatics around I,
II, VII and VIII cranial nerves.
The appendix is most often found in retrocaecal
position.
Juxta glomerular cells are smooth muscular
cells of afferent arteriole.
Fascia of Gerota is thoracolumbar fascia.
Isthmus of the thyroid gland is found across 3-
5 th tracheal rings.
Neural tube develops from ectoderm.
The movement of version of the foot takes place mainly in
subtalar joint, calcaneonavicular and calcaneocuboid joints.
Incisior foramina in the mouth are foramen of
Vesalli.
Peroneal artery is a branch of posterior tibial
artery.
Unlocking of knee joint to permit flexion is
caused by popliteus.
Longest muscle or Tailor's muscle in body is
sartorius.
Boxer's muscle is serratus anterior.
Toynbee's muscle is tensor tympani.
Muscle used for grinning is Risorius.
OS trigonum is atavistic type of epiphysis.
Umbilical vesicle attains full development in 4
weeks of foetal development.
The principal sensory nerve of the larynx is the
superior laryngeal nerve.
The central canal of spinal canal is central in
lumbar region.
Atriventricular (A-V) node is supplied by right
coronary artery.
Sinoartrial node is situated at the junction of
SVC and right atrium.
Koch's triangle is bounded by septal leaflet of
tricuspid value, tendon of Todaro and orifice of
coronary sinus.
Germ cells in ovary develop from yolk sac.
Base of heart is formed by both atria.
Lymphatics from testes or ovaries drain into
para aortic lymph nodes.
Broca's area is situated in inferior frontal gyrus.
Tail of pancreas contains more islets of
Langerhans.
Saphenous opening is below and lateral to
pubic tubercle.
Thymus develops from endoderm of III
pharyngeal pouch.
Cell bodies of II order neuron for pain are
situated in spinal cord.
In Wolf Parkinson White Syndrome, there is
connection between atria and ventricles.
C-cells in thyroid gland are derived from
Ultimobranchial body.
Lymphatics from tonsil drain into
Juguloomohyoid nodes.
J receptors are situated in alveolar epithelium.
Swallowing centre is situated in medulla.
Angle of mandible is supplied by greater
auricular nerve.
Nasolacrimal duct drains into middle meatus.
Injury to axillary nerve mainly causes loss of
abduction.
Wrist drop (injury in upper arm) or Saturday
night palsy injury in radial groove is caused by
radial nerve injury.
Adult larynx extends from C3 to C6.
Great vein of Galen drains into straight sinus.

Duct of Sylvius also called cerebral aqueduct


connects III and IV ventricle.
When testicular veins are ligated, the testes
are drained by cremasteric veins.
Horner's Syndrome consists of miosis, ptosis
and anhidrosis.
Uterus develops from Mullerian duct.
Callot's triangle is bounded by inferior border
of liver, common hepatic duct and cystic duct.
Failure of fusion of ostium primum and ostium
secundum leads to patent foramen ovale.
Oogonia are supplied from Yolk sac.
Cartwheel appearance of nucleus is seen in
Sertoli cells.
Pinna is fully formed at birth.
Ligament of Bigelow is present in hip joint.
Uterine artery is a branch of anterior internal
iliac artery.
The narrowest part of male urethra is external
meatus.
Ophthalmic artery is a branch of cerebral part
of internal cartoid artery.
Wharton duct drains submandibular gland.
Clavicle is the first bone to ossify.
Paralysis of gluteus maximus is most
noticeably affected the gait cycle at heel strike.
Femur is the longest and strongest bone of the
body.
The ischiofemoral ligament is most taut when
femur is extended.
11th and 12th ribs are floating ribs.
Cremasteric artery is a branch of inferior
epigastric.
The largest cranial nerve is trigeminal.
Deep artery of Penis is a branch of internal
iliac.
Ejaculation is a fraction of sympathetic
nervous system whereas erection is of
parasympathetics.
Cystic artery is a branch of right hepatic.
Trochlear nerve has the longest intracranial
course.
Vertebral veins drain into brachiocephalic
veins.
Ovum was discovered by von Baer.
Kerckring's centre for ossification is associated
with occipital bones.
Foramen rotundum transmits maxillary nerve.
Gartner's duct is a remnant of Wolffian duct.
Primordial germ cells are first seen in wall of
yolk sac.
Father of Modern anatomy is Andreas
Vesalius.
William Harvey described human blood
circulation.
Vocal cords are abducted by Posterior
cricoarytenoid.
Spinal cord in an adult ends at level of LI
Mitral orifice lies at level of 4th costal
cartilage.
The central structure of axilla' is said to be
axillary artery.
Strongest ligaments of sacroiliac joint are
interosseus ligaments.
The ligamentum arteriosum extends between the
concavity of the aortic arch and the left pulmonary artery.
It is remnanl the ductus arteriosus, a channel which
conducted deoxygenated blood from the pulmonary artery
to the aorta during fetal 1
The transverse fissure is found only in the
right lung.
A section of the upper lobe consisting of two
bronchopulmonary segments is known as the
lingula.
The surface markings from the lower border of the lungs
during quiet breathing are the 6th costal cartilage, 8th rib
in the axillary line, and the 1 Oth thoracic spine.
The Thoracic duct passes through the aortic
opening in the diaphragm.
The thoracic duct drains lymph from all over the body,
except from the right side of the heart and the right upper
limb.
The joint between the head of a typical rib and
two vertebral bodies is synovial.

The sternal and costal parts of diaphragm are derived from


the septum transversum; a gap between these two parts is
known as foramen of Morgagni.
An abnormal foramna (of Bochdalek) is sometimes found
between the central tendon and the lumbar section of the
diaphragm, it is usually left-sided.
The pool of CSF in the lower lumbosacral region is called
the lumbar cistern. It contains the roots of the lower spinal
nerves (cauda equina) and the filum terminale. The spinal
cord usually ends at the level of L,, in the adults. The aorta
bifurcates at the level of L4. Mamillary processes are
features of lumbar vertebrae. T, is responsible for the
supply of the intrinsip muscles of the hand.
The only nerves contained within the spermatic cord are
sympathetic nerves and the genital branch of
genitofemoral nerve. A direct inguinal hernia pushes
through the posterior wall of the inguinal canal, medial to
the deep ring. An indirect inguinal hernia, on the other
hand, passes along a patent processus vaginalis within the
cord.
The formation of the portal vein by the union of the
superior mesenteric and splenic veins takes place behind
the neck of the pancreas.
The gastroduodenal artery is an important posterior
relation of the first part of the duodenum, and is the artery
which may be eroded by a posterior duodenal ulcer.
The Ligamentum teres is a remnant of the left umbilical
vein, which drained into the left branch of the portal vein in
the fetal liver.
The hepatic artery lies on left of CBD and the portal vein
behind. Although this is the usual arrangement, variations
are sometimes found.
The artery lies to the medial side of the neck of the
indirect inguinal hernia; it lies lateral to a direct inguinal
hernia. Pararenal fat (Zuckerkandl) is found behind the
renal fascia: Perirenal fat (Gerota) lies between the
capsule of the renal fascia.

The Median umbilical ligament is a remnant of the vitelline


or yolk duct.
The external ring is an opening in the external oblique
aponeurosis just above the crest of the pubis. Fertilization
usually takes place in the ampulla.
The sternal and costal parts of diaphragm are derived from
the septum transversum; a gap between these two parts is
known as foramen of Morgagni.
An abnormal foramna (of Bochdalek) is sometimes found
between the central tendon and the lumbar section of the
diaphragm, it is usually left-sided.
The pool of CSF in the lower lumbosacral region is called
the lumbar cistern. It contains the roots of the lower spinal
nerves (cauda equina) and the filum terminale. The spinal
cord usually ends at the level of L,, in the adults. The aorta
bifurcates at the level of L4. Mamillary processes are
features of lumbar vertebrae. T, is responsible for the
supply of the intrinsip muscles of the hand.
The only nerves contained within the spermatic cord are
sympathetic nerves and the genital branch of
genitofemoral nerve. A direct inguinal hernia pushes
through the posterior wall of the inguinal canal, medial to
the deep ring. An indirect inguinal hernia, on the other
hand, passes along a patent processus vaginalis within the
cord.

The formation of the portal vein by the union of the


superior mesenteric and splenic veins takes place behind
the neck of the pancreas.
The gastroduodenal artery is an important posterior
relation of the first part of the duodenum, and is the artery
which may be eroded by a posterior duodenal ulcer.
The Ligamentum teres is a remnant of the left umbilical
vein, which drained into the left branch of the portal vein in
the fetal liver.
The hepatic artery lies on left of CBD and the portal vein
behind. Although this is the usual arrangement, variations
are sometimes found.
The artery lies to the medial side of the neck of the indirect
inguinal hernia; it lies lateral to a direct inguinal hernia.
Pararenal fat (Zuckerkandl) is found behind the renal
fascia: Perirenal fat (Gerota) lies between the capsule of
the renal fascia.

The Median umbilical ligament is a remnant of


the vitelline or yolk duct.
The external ring is an opening in the external
oblique aponeurosis just above the crest of the
pubis.
Fertilization usually takes place in the ampulla.
The Tendo calcaneus (Achilies tendon) is the
common tendon of gastrocnemius, soleus and
plantaris.
The gastrocnemius is a powerful plantarflexor
of the foot but can also act as a flexor of the
knee.
Both cruciate ligaments play a part in limiting
medial rotation of the tibia (lateral rotation of
the femur).
The articular surfaces of the subtalar joint are
covered with hyaline cartilage.
The subtalar joint lies between the talus and
calcaneus.
The movements of inversion and eversion take
place at the subtalar and talonavicular joints.
It is medial ligament of ankle joint which is
usually referred to as the deltoid ligament.
The tibial collateral ligament is a broad flat
band, the fibular collateral ligament is a
rounded cord.
The common peroneal nerve travels to the lateral side of
the popliteal fossa. The tibial collateral ligament is closely
related to the medial interior genicular vessels and nerve.

The structures which pass deep to the retinaculum from


medial to lateral are : tibialis posterior, flexor digitorum
longus,posterior tibial vessels, tibial nerve, and flexor
hallucis longus.
A branch of the obturator artery enters the head of the
femur: other nutrient vessels enter the neck of the bone.
Tensor fasciae inserts into the iliotibial tract. Muscles
which insert into the greater trochanter include gluteus
medius,gluteus minimus, piriformis and obturator internus.
Obturator externus inserts into the trochanteric fossa.

Blood brain barrier is made up of : (1) the vessel wall;


(ii) the arachnoid layer of perivascular sheath; (iii) the
perivascular space; (iv) the pial layer of perivascular
sheath, and (v) the neuroglia and the ground substance of
the brain. The barrier, at the capillary level, is reduced to
the mere capillary endothelium with neuroglia and ground
substance.
Hemiplegia of an upper motor neuron type is usually due
to an internal capsular lesion caused by thrombosis of one
of the lenticulostriate branches of the middle cerebral
artery (cerebral thrombosis).
One of the lenticulostriate branches is most frequently
ruptured (cerebral haemorrhage); it is known as
Charchot's artery ofcerebral haemorrhage. This lesion also
produces hemiplegia with deep coma, and is ultimately
fatal.
Thrombosis of the Huebner's recurrent branch of anterior
cerebral artery causes contralateral upper monoplegia.
Thrombosis of paracentral artery (terminal cortical branch
of anterior cerebral artery) causes contralateral lower
monoplegia.

Thrombosis of posterior inferior cerebellar artery causes


lateral medullary syndrome (Wallenberg's syndrome). It is
characterized by :
a.Severe giddiness, due to involvement of vestibular
neclei
b.Dysphagia, due to involvement of the nucleus
ambiguus.
c.Crossed hemianaesthesia, due to involvement of the
lateral spinothalamic tract (contralateral body) and nucleus
of the spinal tract of trigeminal nerve (ipsilateral face).
d. Horner's syndrome due to involvement of
sympathetic pathway in the medulla.
e.Cerebellar symptoms and signs.

Pontine haemorrhage is characterized by (i) paralysis


(contralateral hemiplegia); (ii) deep ctfma; (iii)
hyperpyrexia; and (iv)pin-point pupil. It is invariably fatal.
The hunger or feeding centre is placed laterally; the satiety
centre, medially in hypothalamus.
The thirst or drinking centre is situated in the lateral part
of hypothalamus.
Father of Anatomy Herophilus.
Largest organ of body Skin.
Largest sesamoid bone of bodyPatella
Largest gland of body Liver.
Largest branch of femoral artery Profunda
femoris artery.
Largest ganglion of neck is Superior cervical
ganglion.
Largest vein of body is long saphenous vein.
First teeth to appear in infant are Lower
central incisor.
First permanent teeth to appear are First
Molar.

First bone to ossify in bodyClavicle.


Second bone to ossify in body Mandible.
Most common cause of nerve root compression
in neck Cervical spondylosis.
Embryonic disk develops during Third week.
Largest branch of femoral Nerve Saphenous
nerve.
where parietal bones meet each other.
First endocrine gland to appear in foetus
Thyroid gland.
Bregma is the pointWhere sagital and coronal
sutures meet.
Lambda is the pointWhere sagittal and
lambdoid sutures meet.
Lambda lies at the location of Posterior
fontanelle.
Lambdoid suture lies between Parietal and
occipital bones.
Sternocleidomastoid is innervated by Spinal
accessory N. & C2, C3 Spinal N.
Trapezius is innvervated by Spinal accessory
N. &C3, C4 Spinal N.
Minimum time required for irreversible brain
death due to ischemiaFour minutes.
Clinically most important layer of scalp is
Loose areolar tissue.
Kyphosis is an exaggerated thoracic curvature.
Lordosis is an exaggerated lumbar curvature.
Scoliosis is a lateral curvature.
First cervical vertebral is called Atlas.
Second cervical vertebra is called Axis.
An upward projection present in second cervical
vertebra is called Dens.
Transverse foramen is characteristic of
Cervical vertebrae.
Transverse formen transmits Vertebral artery.
Structure transmitted in intervertebral canal is Spinal
nerve.
Nucleus pulposus, is the remnant of Notochord.
Digastric triangle and submandibular fossa of mandible.
Sphenoethmoidal recess is a depression lying above and
behind the superior choncha. It receives the opening of
sphenoidal air sinus.
Superior meatus receives the opening of posterior
ethmoidal air sinuses.
Middle meatus receives the opening of middle ethmoidal
air sinuses on or above the bulla ethmoidalis and maxillary
sinus opening in the floor of hiatus semilunaris.
Anterior meatus receives the opening of naso lacrimal
duct. Opening is guarded by a fold of mucous membrane
which forms a valve.
Uvula is a conical (projection) process hanging from middle
of posterior border of soft palate.
Dorsal surface of tongue is divided into posterior 1/3 and
anterior 2/3 by a 'V shaped sulcus terminalis. Papillae of
the tongue are filiform, fungiform and circumvallate
papillae
Foreign body removal from pyri form fossa may damage
the internal laryngeal nerve resulting in anaesthesia of
laryngeal mucous membrane upto vocal cords.
Erb's point' is the meeting point of two roots C3, C6, two
divisions of upper trunk (anterior and posterior); and two
nerves viz. supra scapular and nerve to subclavius. Stretch
of this point leads to Erb's paralysis.

External Jugular vein pierces the deep cervical fascia


before it drains into the subclavian vein. The walls of the
vein are adherent to the deep fascia and this factor
prevents the retraction of vein when cut. Hence the
opening should immediately be closed by applying
pressure otherwise air may be sucked in during inspiration.
True capsule of thyroid gland has to be removed during
thyroidectomy along with the gland as the major vessel
trunks pass through the space between true and false
capsules and there is a rich plexus of vessels immediately
beneath the true capsule. Rupture of veins draining from
upper part of nasal septum (Joining the inferior cerebral
veins in cranium) may be the source of severe nasal
bleeding in elderly hypertensive patients.

Sibson's fascia is Suprasternal space.


Suprasternal space of 'Burns' is space above upper margin
of manubrium sterni with in the general investing layer of
deep cervical fascia.
Typical intercostal space is the space present between two
typical ribs (i.e 3rd, 4th, 5th and 6th spaces) and
transversed by vessels and nerves confined to thoracic
wall. Angle of Louis is sternal angle.
Typical intercostal nerves are 3rd, 4th, 5th, 6th, intercostal
nerves; these run in typical intercostal space and supply
the structures of that intercostal space only.

Anteriorly 2nd to 4th tracheal rings are related to isthmus


of thyroid gland.
Trachea divides into right and left principal bronchi, Right
principal bronchus is 2.5 cm long and in line with trachea
and left runs transversely.
Right principal bronchus divides into 3 lobar bronchi and
left principal bronchus divides into 2 lobar bronchi.
There are 10 bronchopulmonary segments in each lung.
In its course thoracic duct is behind and to the right of
oesophagus in the lower part, crosses the midline at 5th
thoracic vertebral level behind oesophagus then lies to the
left of oesophagus in the rest of its course.
Thoracic duct passes from abdomen to thorax through
aortic opening of diaphragm.
Suprapleural membrane is a membrane which expands
over cervical pleura and is attached infront to the 1st rib
and behind to the transverse process of 7th cervical
vertebra. This is also called Sibson's fascia.
Innervation by intercostal nerves makes the parietal pleura
sensitive to pain.
Arrangement of structures in each intercostal space is vein,
artery and nerve (VAN) from above downwards except in
upper spaces. Here the nerve is at first above the posterior
intercostal artery. '
Symphathetic nerves cause bronchodilatation. 1
Suprapleural membrane is regarded as the tendon of
scalenus minimus.
Fibers from thoracic part of sympathetic trunk pass in
greater splanchnic (branches of 5th to 9th ganglia); lesser
spanchnl (branch of 12th thoracic ganglion) nerves.
Weakest point of the rib is the region infront of the neck.
This is the usual site for fracture.
Mediastinal and central diaphragmatic pleura are
innervated by phrenic nerve; hence irritation causes
referred pain to should tip or lower neck i.e. the area of
skin supply by same spinal segments (C3, C4).
Diagnostic radiological finding in pleural effusion is
obliteration of costo diaphragmatic recess.
Achalasia (cardio-spasm) is due to congenital absence of
nerve cells of oesophagus resulting in neuromuscular
incoordination
Telencephalon is End brain (cerebral hemispheres).
Diencephalon is Thalamus, epithalamus, hypothalamus,
subthalamus.

Mesencephalon is Mid brain. Rhombencephalon is Hind


brain.
Metencephalon is Pons.
Myelencephalon is Medulla oblongata.
Brainstem mean Mid brain, pons, medulla.
Sulcus mean surface depression.
Gyrus means surface elevation.
Cortex Grey matter cover surface of cerebral
and cerebellar hemispheres.
Rhomboid fossa is floor of 4th ventricle.
Calamus scriptorius is caudal end of rhomboid
fossa (resembles nib of a pen).
Locus ceruleus is bluish grey area in floor of 4th
ventricle.
Restiform body is large lateral component of
inferior cerebellar peduncle.
Juxtarestiform body is small medial component
of Inferior cerebellar peduncle.
Brain and spinal cord are enclosed in meninges
dura, arachnoid and pia.
Cranial dura has two layers, an outer endosteal
and an inner meningeal layers.
Spinal dura is continuation of meningeal layer.
CSF is formed either by secretion or
ultrafiltration from choroid plexus.
Blood vessels of brain run in subarachnoid
space.

Medualla oblongata continues as spinal cord


at the upper border of atlas.
Filum terminale is a connective tissue filament extending
from conus medullaris to the 1st coccygeal segment, Initial
15 cm of
this is filum terminale internum and extends upto 2nd
sacral vertebral where dura and arachnoid meninges stop.
Last 5 cm is filum terminale externum, contains only pial
extension and terminates at 1 st coccygeal segment.
Cervical enlargment of spinal cord corresponds to C3 to T2
spinal segments; lumbar enlargment corresponds to L1 to
S3 spinal segments.
In spinal cord, grey matter is inside and presents anterior
and posterior horns; white matter is outside and is divided
into posterior, lateral and anterior funiculi by emerging
dorsal and ventral roQts of spinal nerves.
Grey matter is traversed by Central canal and white matter
has ascending and descending tracts.
Posterior funiculus has fasciculus gracillis and cuneatus.
Anterior 2/3 of cross sectional area of Spinal cord is
supplied by branches of anterior spinal arterior and the
rest by posterior spinal artery and pial plexus.

Cervical 8, Thoracic 12, Lumbar 5, Sacral


5, coccygeal 1.
Basal ganglia include caudate nucleus and
lentiform nculeus.
Corpus striatum includes caudate nucleus and
lentiform nucleus.
Putamen and globus pallidus are subdivisions of
lentiform nucleus.
Paleo striatum is globus pallidus.
Corpus callosum is a great cerebral
commissure.
Ventricles are cavities lined with ependyma and
contain CSF.
Illrd ventricle and IVth ventricle communicate
with each othr through cerebral aqueduct.
IVth ventricle has a floor (Rhomboid fossa) and
a roof.
Sacral outflow is from SI, S2, S3 spinal
segments.
Retrolentiform and sublentiform, parts of
internal capsule have optic and auditory
radiations respectively.
Basal vein is formed by union of deep middle cerebral vein,
anterior cerebral vein, and striate veins. It opens into great
cerebral vein.
Choroidal vein and thalamostriate vein unite and form
internal cerebral veins.
Great cerebral vein is formed by the union of two internal
cerebral veins
Sciatic nerve is a branch of sacral plexus - its tibial
component is L4, L5,, S1, S2 and common peroneal
component is L4, S1.S2.
Main role of menisci of knee joint is in Rotation.
Main dorsiflexor of foot is Tibialis anterior.
Highest point of medial longitudinal arch of foot
is at Head of talus.
Most important ligament in maintainance of
medial longitudinal arch is Spring ligament.
Abductor compartment of thigh is represented
in upper limb by Nervus hesitans.
Nerve involved in Meralgia paraesthetica is
Lateral cutaneous nerve of thigh (L2,3).
Blood supply to S.A. node of heart is derived
from Right coronary artery.
Cusps of Semilunar valve of Aorta are One
anterior and two posterior.
Cusps of semilunar valve of Pulmonary trunk
are one posterior and two anterior.
Cusps of tricuspid valve are Septal, Anterior,
Posterior.

Papillary muscles of right ventricle are Septal,


Anterior, Posterior.
Circumflex branch of left coronary artery
supplies mainly Left atrium.
Apex of heart is situated at Left fifth
intercostal space.
Chief muscle of inspiration is Diaphragm.
Motor nerve of diaphragm is from Phrenic
nerve (C3,4,5)

Bronchopulmonary segment is not a bronchovascular


segment because It has not got its own vein lies in
intersegmei plane.
Thinnest wall of all the four -chamber of heart
is of Right atrium.
Bundles of Kent are (cause of W.P.W. syndrome)
Abnormal muscle bridges between atria and
ventricle.
Duration of cardiac cycle is 0.8 second.
Early functional closure of foramen ovale is
mainly due to Pressure difference.
Initial closure of ductus arteriorus is mainly due
to Muscular contraction (Mediated by
bradykinin).
Anterior vagal trunk at oesophageal hiatus is
formed by Left vagus.
Posterior vagal trunk at oesophageal hiatus is
formed by Right vagus.
Tricuspid orifice of heart is located at Right
fifth Interocostal space.
Action of vagus nerve on heart is Inhibitory.
Action of vagus on gut is Facilitatory.
Angle of Louis (Sternal angle) is located at
Articulation of second rib.
Ligamentum arteriosus is present in between
Left pulmonary artery and arch of aorta.
Inferior venacava enters right atrium at the
level of Sixth chondro-sternal joint.
Trachea bifurcates at the level of Lower
border of Fourth thoracic vertebra (in cadaver).
Level of beginning of arch of aorta is T4-
Vertebra.
Level of thoracic aorta piercing diaphragm is
T12 - Vetebra.
Level of of Oesophagus passing through
diaphragm is T10.
Azygous vein crosses to opposite side at the
level of T4
Level of inferior venacava piercing diaphragms
is T8.
Level of transpyloric plane is at LI.
Coeliac artery arises from abdominal aorta at
the level of T12.
Superior venacava develops from Right
common cardinal vein, Right anterior cardinal
vein.
Coronary sinus develops from Left horn of
sinus venosus, Left common cardinal vein.
Left umblical vein ends into Left branch of
portal vein.
Muscles of back get motor innervation from
Dorsal primary rami.
Contents of lieno-renal ligament are Splenic
artery and tail of pancreas.
Space of Disse is a space between
hepatocytes and hepatic sinusoids

Erb's Paralysis ...Forcible widening of the angle between


the head and the shoulder, upper trunk at Erb's point
sustains injury resulting in Erb's paralysis. This leads to
Porter tip deformity.
Klumpke's paralysis....Hyperabduction of arm results in
damage to C8 Tl and sometimes Cl roots. Paralysis affects
intrinsic muscles of hand and flexors of wrist and fingers.
Injury to roots.... (Tearing away of 1st thoracic root)
associated with cervical sympathetic paralysisHorner's
syndrome. This is characterized by constriction of pupil,
ptosis, apparent enophthalmos, anhidrosis on affected side
of face and netk.
Crutch paralysis....Radial nerve is damaged due to
pressure of crutch on radial nerve.
Sleep paralysis....Median and radial nerves suffer due to
pressure effet while the patient is asleep under the
influence < alcohol.
Winging of scapula ....Due to paralysis of long thoracic
nerve common in people carrying heavy weights on
shoulder for the nerve is exposed to injury in posterior
triangle, (porter's paralysis).
Ape hand is due to median nerve injury proximal to origin
of its muscular and anterior interosseous branches.
Pointing index finger ...lesion produced due to injury of
median nerve just above the middle of forearm. There is
on| weakness in flexion of index finger as the nerve to that
part of flexor digitorum superficialis is given at about the
middle forearm.
Carpal tunnel syndrome is due to pressure on median
nerve in carpal tunnel.
Ulnar claw hand is due to injury to ulnar nerve....Mild
degree of clawing observed which leads to extension of 1
st phalanges of 4th & 5th fingers and flexion of 2nd and
3rd phalanges. .
True claw hand... a combined ulnar and median
nerve lesions at elbow causes 'true claw hand.
Clitoris develops from Genital tubercle.
Portal vein develops from Vitelline veins.
Falciform ligament is derived from Ventral
mesogastrium.
Macula Densa is related to Distal tubule of
kidney.
Safety muscle of Tongue Genioglossus.
The structure lodged in Meckel's cave is
Trigeminal ganglion.
Thyroid gland is attached to cartilages of larynx
by Pretracheal fascia.
Middle meningeal artery is a branch of
Maxillary artery.
Adam Kiewicz artery supplies Spinal cord.
Enteric reflexes causing segmental and pendular
movement of gut may be explained by Bayliss-Starling
law of gut.
Most common site of diverticulosis coli is
Sigmoid colon.
Left colic artery is a branch of -Inferior
mesenteric artery.
Uvula vesicae is produced by Median lobe of
prostate.
Floor of retropubic space is formed by
Puboprostatic ligament.
Fascia of Denon viller is present between
Rectum and Prostate.
Number of rectal valve is Three.
Hilton's line is Ano-cutaenous junction.
Tngone of urinary bladder develops from
Mesonephric duct.
Artery to vas deferens is a branch of Inferior
vesical artery.
Anteversion' of uterus is the angle between
long axis ofCervix and vagina (90 degree).
Anteversion on' of uterus is the angle between
long axis ofCervix and body of uterus (120
degree).

Anti 'Rape' muscle is Gracillis.


Falx cerebelli separates the two lobes of
cerebellum.
Tentorium cerebelli separates occipital lobes
and cerebellum.
Central sulcus (Fissure of Rolando) extends in a
coronal plane and divides frontal lobe from
parietal lobe.
Calcarine fissure is present only in medial
aspect and bisects occipital lobe in a transverse
plane.
Left cerebral hemisphere in most persons is concerned
with verbal, calculating and analytic thinking as well as
interpretation speech, stereognosis and motor function of
right hand.
Right cerebral hemisphere in most persons is concerned
with Nonverbal, spatial, temporal and synthetic function,
appreciation, art and music and motor function of left
hand.
Frontal lobe is mainly concerned with Motor,
speech,cognition,Highest levels of affective behaviour.
Parietal lobe is mainly concerned with somatosensory
processing, so damage to specific locations correlates with
paraesthesia at opposite side of body.
Occipital loije is mainly concerned with visual sensation, so
lesions to occipital cortex leads to contralateral
homonymous anopia. Lesion to visual association areas
leads to alexia or visual agnosia.

Temporal lobe is mainly concerned with memory,


audition,
Limbic lobe is concerned with olfaction, emotions,
behavioral activity.
Thalamus serves as a major synaptic relay station.
Damage to subthalamic nuclei leads to Ballismus.
Damage to substantia nigra leads to Parkinsonism
(Paralysis agitans), due to reduced dopamine
production.
Trigeminal nerve emerges from pons laterally and
abducens nerve emerges anteriorly at pontomedullary
junction.
About 20 olfactory nerves pass from nasal mucosa to
olfactory bulbs via cribriform plate, so they are a
important source)
Meningitis.
Mitral cells is the second order neuron of first Cr.
Nerve.
Optic nerve is actually a tract of brain, carrying
meningeal sheaths complete with durameter,
arachnoidmater, subarachno
space and piamater. So intracranial pressure of C.S.F.
is directly reflected in subarachnoid space of optic
nerve. High intracranial pressure causes papilloedema
(Oedema at optic disc).
True equivalent of optic nerves are represented in
retina by Bipolar cells.
Edinger-Westphal nucleus gives rise to
parasympathetic component of oculomotor nerve.
This nucleus supplies ciliary muscles and sphincter of
pupil via ciliary ganglia.
Largest of cranial nerves is trigeminal
Mesencephalic Nucleus of trigeminal receives fibers
carrying proprioception i.e. Jaw Jerk reflex.
Most striking disorder of Trigeminal nerve fucntion is
Tic douloureux.
Nervus intermedius of Wrisberg is small sensory
component of facial N.
Represents nerve of the 4th and 6th branchial arches.
Torticollis is the spasm of sternomastoid and trapezius
due to irritation of the Xlth Cr. nerve.
Blood supply of brain occurs by two vertebral arteries
and two internal carotid arteries.
Branches of Internal carotid artery are :
Ophthalmic artery
Posterior communicating artery
Anterior cerebral artery
Middle cerebral artery.
Branches of Vertebral Arteries are :
Posterior inferior cerebellar artery
Anterior spinal artery
Basilar artery
Branches of Basilar Artery are :
Anterior - inferior cerebellar arteries.
Pontine arteries
Superior cerebellar arteries
Posterior cerebellar arteries.

Oculomotor Nerve emerges between posterior


cerebral and superior cerebellar artery.
Circle of Willis which is formed by branches of
Internal carotid and Basilar artery. It is complete in 90
% individuals and I
circle is an important site of Berry aneurysm.
Anterior spinal artery is one in number, whereas
posterior spinal arteries are two in number
Anterior spinal artery arises from Vertebral artery.
Posterior spinal arteries arise from Posterior inferior
cerebellar artery.
The Dorsal root of spinal nerve contains only sensory
fibres
The ventral root of spinal nerve contains only motor
fibres.
The cervical roots (Except C6) exit from neural
foramina above their respective vertebral bodies, while
thoracic and lumbar oots exit below each body.
Waldeyer's ring is a ring of lymphoid tissue around
pharynx. This ring is formed by pharyngeal, tubal,
palatine and lir
tonsils.
First arch is called Mandibular arch.
Second arch is called Hyoid arch.
Artery of first branchial arch is Maxillary
artery.
Cartilage of first arch is called Meckel's
cartilage.
Nerve of second branchial arch is Facial N.
Artery of Second arch is Stapedial artery.
Nerve of third branchial arch is
glossopharyngeal N.
Muscle derived from third arch is
stylopharyngeus muscle.
Cartilage of third arch forms greater cornu of
hyoid and inferior part of body of hyoid bone.
Nerve of fourth arch is superior laryngeal nerve
and nerve of sixth arch is recurrent laryngeal
nerve.
Mdian (Pterigoid) canal transmits Vidian N. (Formed by
Greater superficial petrosal nerve and deep petrosal
nerve).
Optic canal transmits optic nerve, ophthalmic artery and
central vein of retina.
Superior orbital fissure transmits Illrd, IVth,
ophthalmic division of Vth and Vlth cranial N.
and ophthalmic vein.
Inferior orbital fissure transmits Infraorbital
branch of maxillary division of trigeminal nerve.
Internal auditory meatus transmits Vlth and
VHIth cranial N.
Right common carotid artery arises from
Branchiocephalic artery.
Tenon's capsule is a connective tissue socket in
which eyeball is suspended.
Cornea is the main refractor of eye.
Sphincter pupillae consists of myoepithelial cells arranged
in a circle around pupil. It is under parasympathetic
control.
Dilator pupillae consists of myoepithelial cells arranged in a
radial. It is under sympathetic control.
Aqueous humor is secreted by ciliary process into posterior
chamber.
Aqueous humor is formed by ultrafiltration (25%) and
active ciliary secretory process (75%)
Aqueous humor passes through pupil into anterior
chamber and then through Schlemm's canal drains into
venous system.
Retina is derived from optic vesicle, an evagination of
brain.
Circulus Iridis major is situated in root of iris.
Retinal arteries are the only arteries, which can be directly
examined for systemic diseases,
Anterior chamber of eyeball is situated between cornea
and iris.
Posterior chamber is situated between iris and lens.
External auditory meatus has 2 parts. Outer one third is
cartilaginous and inner two third is bony.

Axilla is a pyramidal space containing cords & branches of


brachial plexus, axillary vessels, lymph nodes & fat.
Apex of axilla is bounded by 1 st rib, clavicle and scapula.
Anterior axillary fold is formed by pectoralis major.
Posterior axillary fold is formed by teres major and
latissimus dorsi.
Mammary gland is located in superficial fascia. It extends
from 2nd to 6th ribs; from parasternal region to
midaxillary line at 4 th costal cartilage level.
Structures passing through Quadrangular space
are axillary nerve and posterior circumflex
humeral vessels.
Nerve of flexor compatment is musculo cutaneous nerve
(C5,C6,C7) and extensor compartment is radial nerve
(C5,C6,C7,C8,T1).
Anatomical snuff box is the space present on lateral aspect
ofwrist and is bounded by abductor pollicis longus and
extensor pollicis brevis laterally (anteriorly) and extensor
pollicis longus medially (Posteriorly).
Axillary nerve passes through quadrangular space curving
around the surgical neck of humerus.
Radial nerve in the spiral groove is covered posteriorly by
lateral head of triceps brachii muscle.
Radial bursa is the synovial sheath covering flexor pollicis
longus and extends upto its insertion.

Myelin of peripheral nerves is produced by "Schwann


cells" and of central nervous system is by
oligodendrocytes.
Spinal nucleus of trigeminal nerve is in continuation below
with substantia gelatinosa of Rolando.
Facial colliculus is an elevation in the floor of IVth ventricle
produced by the fibres of facial nerve as they are turning
round the nucleus of abducent nerve.
Temporal lobe is closely associated with memory (short
term memory).
Cerebellum is connected to medulla by inferior; to pons by
middle; and to mid brain by suprior cerebellar peduncles.
The trigeminal is the only nerve having primary sensory
neurons within the brainstem-(Mesencephalic nucleus of
trigeminal nerve in mid brain).
Eye of the handmedian nerve as it is sensory to the
most part of the palm of hand.
Lumbar puncture can be done to obtain CSF by passing a
needle between laminae or spines of L3 & L4 vertebrae as
the spinal cord ends at the lower border of LI or upper
border of L2 vertebra.
Cerebello medullary cistern is selected for cisternal
puncture.
Usually cerebral haemorrhage is due to rupture of
Charcot's artery (one of lateral striate branch of middle
cerebral artery).
Macular area in occupital lobe is supplied by both middle
and posterior cerebral arteries. In states of blockage of
middle cerebral artery, posterior cerebral artery takes over
the supply thus "Sparing the macular area".
Rupture of middle meningeal artery leads to extradural
haematoma.
Rupture of cerebral veins leads to subdural haemotoma.
Subarachnoid space is continuous along the optic nerve as
far as lamina cribrosa. Increased intracranial tension due
to excess of fluid in the space produces papilloedema.
Lateral geniculate body is concerned with Light reflex.
Medial geniculate body is concerned with auditory
pathway.
Arch of aorta develops from Left sided fourth arch artery.
Pulmonary artery develops from sixth arch artery.
Artery of first branchial arch is Stapedial artery.
The nerve piercing supinator muscle is Posterior
interosseus nerve.
Space of Kanavel is Mid palmar space.
Ligament of Struther represents Third head of
coracobrinchialis.
Basilic vein pierces deep fascia at the level of Insertion
of Coracobrachialis.

'Holden's line is The line along which the membranous


layer of superficial fascia is attached to deep fascia of
thigh.
Nerve winding around the neck of fibula is Common
peroneal N.
Main extensor of thigh is Gluteus maximus.
Most powerful ligament of hip joint is L3 - L4.
Narrowest part of oesophagus is at cricopharynx.
Sphincter at lower end of oesophagus is physiological.
Main blood supply of oesophagus:
Upper thirdfrom inferior thyroid artery
Middle thirdAorta.
lower thirdLeft gastric artery.
Pyloric sphincterIt continues in duodenum at
pyloroduodenal junction, which is demarcated externally
by 'Bloodless white line'. This line is the distal extend of
congenital hypertrophic pyloric stenosis.
Bare area of stomach is a small area at its posterior
surface near cardia.
Anastomoses between gastric and duodenal arteries are
scanty, giving rise to a 'white line' at pyloroduodenal
junction.
Ligament of Treitz is a surgical landmark of duodenojejunal
flexure. It extends from duodenojejunal flexure to right
cms of diaphragm.
Radiographically, jejunum is characterised by its valvulae
conniventes, which are spaced regularly, giving rise to a
concertina effect.
Radiographically, ileum is recognised as characterless part,
lying mainly in hypogastrium. An individual can lead a
normal life even after resection of upto one third of small
gut. An individual can survive even with one and half feet
of small gut. Main function of colon is conservation of fluid,
shortest part of colon is ascending colon.
Appendicular artery arises from ileocolic artery, whereas
the accessary appendicular artery (if present) arises from
posterior caecal artery.
Most common position on appendix is retrocaecal (65-70%
cases).
Because the appendix develops from midgut; which is
innervated by lesser splanchnic nerve (T10-T11), initial
colicky pain visceral pain) is referred to periumbilical
region (T10-T11)

Most common age group for appendicitis is teenagers


and young adults, because at this age the lumen of
appendix is very narrow.
Ampulla is the widest portion of rectum, lying just above
the pelvic floor. It is usually empty because faeces are
stored in sigmoid colon.
The cardinal features of large gut (i.e taeniae, appendices
epiploicae and sacculations) are absent in rectum.
Houston's valves are semicircular rectal folds present at
inner wall of rectum. They are three in number. because of
mesenteric attachment, liver moves with diaphragm during
respiration.
Anatomically right and left lobe are separated by a line
passing along falciform ligament. The line of division of
surgical lobes passes from gall bladder fossa to inferior
venacava. Liver has been divided into eight segments,
which has got importance in segementectomy of liver,
jixamural portion in the narrowest portion of CBD.
Mucosal fold in cystic duct is called 'Valves of Heister',
which maintains the patency of cystic duct. G3 can
undergo distension upto 50 times.

Posteromedial wall of neck of Gall bladder is dilated, and


is known as Hartmann's pouch.
Calot's triangle is formed by common hepatic duct on the
left, liver above and cystic duct on the right side. In 90%
cases, 3 sac artery lies in Calot's triangle. Failure of
complete rotation of ventral bud leads to annular pancreas.
Portal vein is formed by union of superior mesenteric vein
and splenic vein behind the neck of pancreas at the level of
L2 vertebra.

Portal venous system is valveless.


Horeshoe Kidney is produced due to fusion of
Lower Poles of Kidney (Usually). Ureters pass Anterior
to the isthmus (
Kidney.
Left Kidney is ectopic more commonly than
right.
The epithelium of bladder is thus endodermal
in origin, except that of trigone, which is mesodermal.
Pain sensation of bladder is carried mainly by
parasympathetic nerves.
Numerous prostatic ducts open on posterior
wall of prostatic Urethra on either side of Urethral
crest (Crista Urethralis).
Verumontanum is the widest portion of
Urethral crest.
Microscopically, adrenal cortex has three parts
(G.F.R)
Zona Glomerulosa Outer zone, secretes
Aldosterone
Zona fasciculata Middle zone
Zona Reticularis Inner zone, secretes Sex
hormones.
Adrenal medulla is composed of chromaffin
cells, which secrete noradrenaline and adrenaline.
Arterial supply of adrenals is from three
arteries :
Superior suprarenal artery Arises from
inferior phrenic artery.
Middle suprarenal arteryArises from
abdominal aorta.
Inferior suprarenal arteryArises from renal
artery.
Right suprarenal vein drains into inferior
venacava.
Left suprarenal vein drains into left renal vein
Ectopic adrenal tissue consists of both medulla
and cortex.
Main structure is anal triangle is anal canal and
anus.
Buck's fascia is the deep fascia of penis
which surrounds all three corpus, but does not extend
into glans.
Prostate gland has two parts. Outer zone is
called Prostatic Gland Proper which is the site of
Carcinoma. Inner
occupied by Submucosal Glands and this zone
is called Adenomatous zone (site for benign
enlargement).
An enlarged Prostate is covered by three
capsule :
Prostatic sheath of pelvic fasciaOuter most.
True capsule : Also called surgical capsule. It is
the Compressed outer Zone of prostate gland itself.
Ovarian Ligament is attached between the
medial pole of ovary and Uterine cornu.
Corpus albicantes is the scar of regressed
corpus luteum.
Right ovarian vein drains into inferior
venacava, whereas left ovarian vein drains into left
renal vein.
Urinary bladder is an important support of
anteverted and anteflexed uterus.
Important ligamentous supports of uterus are
Cardinal Ligament, Pubocervical ligament and
Uterosacral ligament.
Mackenrodt's ligament (Cardinal ligament or
Transverse cervical ligament) are the principal support
in retroverted ut
Fertilized ovum is usually implanted in
posterior wall of fundus.
Vaginal fluid is acidic (four in taste), due to
fermentation of glycogen by Doderlein's bacilli in
vaginal cells.
Lower Third of vagina is pain sensitive,
whereas upper two third is pain insensitive.
In Uterus Duplex, there are two uteri but
single vagina.
In Didelphis, there are two uteri and two
vagina.
In Bicornuate Uterus, Uterus has a partition in
its upper part.

Umbilicus corresponds to T10 spinal segment. Deep fascia


is absent over anterior abdominal wall.
Space between the external oblique aponeurosis and
membranous layer of superficial fascia near inguinal region
is called "superficial inguinal pouch".
Inguinal ligament is the folded lower border of external
oblique aponeurosis.
Reflected part of inguinal ligament and pectinate ligament
are other extensions of inguinal ligament.
Superficial inguinal ring is an opening in the external
oblique aponeurosis located just above and lateral to crest
of pubis.
Deep inguinal ring is a gap in transversalis fascia present
about 1.25 cm above mid inguinal point.
Space between hip bone and inguinal ligament is
pelvifemoral space. Through this vessels, nerves and two
muscles pass from abdomen to thigh.
Inguinal canal is a musculo aponeurotic tunnel extending
from deep inguinal ring to superficial inguinal ring. It is
about 4 cm long.
Rectus sheath : An aponeurotic sheath which envelopes
the rectus abdominis muscle. It prevents bow stringing of
the muscle.
Nerve supply of anterior abdominal wall :
From xiphisternum to umbilicus T7, T8, T9
Umbilicus T|{)
From Umbilicus to symphysis T,,, T,2&L,
Vas deferens has a length of 45 cm: It is continuation of
duct of epididymis.

Lesser sac communicates with greater sac through


epiploic foramen.
Stomach is a muscular organ with cardiac and pyloric
orifices and greater and lesser curvatures.
Duodenum: has 1st (ascending) 2nd (descending) 3rd
(horizontal) and 4th parts, describing a 'C shaped curve.
Vasa recta of jenunum are long and of ileum are short.
Payer's patches are present in ileum along the anti-
mesentric border.
Meckel's diverticulum is an embryological remnant of
vitellointestinal duct present in 2% of individuals 2'
proximal toileocaecal junction and 2" in length.
Speculations are present in large intestine as the
longitudinal muscle coat is in 3 longitudinal bands, called
taeniae coli (1.2 mtlong).

Appendix has :Length 9 cm. Position common


position is retrocaecal retrocolic.
Pre or post ileal positions of appendix (come under splenic
or 2 'O clock position as per Treves classification). Base of
appendix is located at Mc Burney's point. Enlargement of
these veins give rise to internal haemorrhoids.
Anal valves are the mucous folds present at lower ends of
anal columns. They join the lower ends of columns.
White line of Hilton is a wavy line situated where
transitional zone ends below. It is at the level of interval
between the subcutaenous part of external sphincter and
lower border of internal sphincter
Bare area of liver is triangular area bounded by superior
and inferior layer of coronary ligament base by groove for
inferior venacava. It is a site of portocaval anastomosis.
Anatomical lobes of liverRight and left lobes; right lobe
includes quadrate and caudate lobes. Division is by
attachment of falciform fold, fissure for ligamentum teres
and fissure for ligamentum venosum. Pancreas is
retroperitoneal organ. Male Urethra has total length 18 to
20 cm.
Prostatic part of male urethra 3 cm longwidest and most
dilatable part.
Prostate is a fibromusculo glandular organ and it has 5
lobes viz anterior, posterior, two lateral and median lobes.

Ovarian fossa is founded anteriorly by obliterated


umbilical artery, posteriorly ureer and intenal iliac artery.
Superficial vessels, nerves and lymphatics of anterior
abdominal wall lie in between the two layers of superficial
fascia. Sensory component for cremasterjc reflex .
Ilioinguinal nerve (LI) and motor component genito
femoral (LI,2) which supplies cremasteric muscle
Gastric canal is a radiological entity extending from
cardiac orifice to angular incisure.
Nerve of Laterjet is the continuation of anterior vagus
nerve ia the lesser omentum 10 to 15 mm away from
lesser curvature
This is responsible for acid secretion.
In foetus, cervix is larger than body of uterus.
Pancreas is retroperitoneal organ.
Greater, lesser and least splanchnic nerves are branches
of thoracic part of sympathetic chain.
Urachus is remnant of allantois.
Defective arterio-venous anastomosis in the gastro
duodenal mucosa may lead to mucosal ischemia and
ulceration.
Sphincter vesicae is supplied by S2, S3 and S4
(Parasympathetic) nerves.
Interval between external oblique aponeurosis and deep
layer of superficial fascia is "superficial inguinal pouch". It
is often occupied by testis in children (in retracted state).
Superficial perineal pouch is open and deep perineal
pouch is closed.
Transverse perineal ligament is thickened ventral part of
perineal membrane.
Temperature of scrotal sac is 3C lower than the
temperature of abdominal cavity. This is probably stabilized
by counter current heat exchange mechanism between
testicular artery and pampiniform plexus of veins.
Peritoneal fluid is instantly absorbed into subperitoneal
lymphatic capillaries near the diaphragm.
Fascia covering under surface of diaphragm extends
through its oesophageal opening and penetrates into
submucosa of oesophgus as "phreno oesophageal
ligament".
Factor holding the duodenojejunal flexure is "ligament of
Treitz".
Tonic contraction of physiological gastro-oesophageal
sphincter prevents the regurgitation of stomach contents
into the oesophgus.
Duodenojejunal flexure is separated from stomach by
greater omentum and transverse mesocolon.
"Payer's patches" of ileum lie along its antimesenteic
border.
Muscle coat in some parts of wall of appendix may be
absent. In these areas mucous membrane of appendix and
peritoneinj are in contact with each other. In such case
infection when present in mucous coat may spread to the
peritoneum.
Suprarenals and kidneys are enclosed in renal fascia.
However suprarenals lie in a separate compartment.
Lowest region of urinary bladder is its neck.
Round ligament of uterus and ligament of ovary are
derivatives of gubernaculum ovary.
Ovarian or testicular arteries (gonadal arteries) are
branches directly from aorta but right gonadal vein drains
to inferior venacava and left gonadal vein drains to left
renal vein.
One of the sites of portocaval anastomosis is in anorectal
wall it is between superio rectal vein, (portal system) and
inferior,middle rectal veins (systemic veins).
Neck of henial sac is medial to inferior epigastric artery in
direct inguinal hernia and it is lateral to artery in indirect
(oblique inguinal hernia.)
Iliopubic tract (thickened lower part of fascia
transversalis) when well developed can be used for hernial
repair.
Tenderness in renal angle indicates kidney pathology.
Diaphagmatic irritation causes referred pain in shoulder
tip. This is due to same spinal segmental involvement
phrenic and supra clavicular nerves have the same root
value C3,4.
In sliding hiatal hernia, there is upward slide of gastro-
oesophagial junction through the lax oesophageal hiatus.
The clampii action of the crura of the diaphragm is lost,
hence there is acid regurgitation.
In para-oesophageal hiatal hernia gastro-oesophagial
junction is normal and only part of fundus of stomach
enters through the oesophageal hiatus and there is no acid
regurgitation.
Gastroduodenal artery is an end artery.
Lesion of vagal trunks at the cardiac end of stomach
might affect the motility of stomach, small intestine, and
large intestine as far as the distal third of transverse
colon.

Carcinoma head of pancreas speedily involves the bile


duct and may cause jaundice or may press on portal vein
and cause ascites or obstruct pylorus.
Blood less zone of Brodel is not blood less in kidney -
Hence radial or intersegmental incisions are preferred
during surgery on kidney.
Safe position to divide the ureter is 2 cm below the
bifurcation of common iliac artery as the inferior vesical
artery supplies the lower part.
Pubococcygeus supports vagina, urethra and anus, Injury
to pubococcygeus and pelvic fascia results in cystocele.
Prostatic tumors may spread to vertebrae as the prostatic
venous plexus drains to inferior venacava through sacral
veins and vertebral venous plexus.
Removal of metastatic lymph nodes from the lateral pelvic
wall may cause damage to obturator nerve (as it runs in
the extra peritoneal tissue of lateral pelvic wall) resulting in
weakness of adduction of thigh on the affected side.

Abscess in the rectouterine pouch can be


drained through posterior vaginal wall at
posterior fornix.
Herniation to ischiorectal fossa is through
"hiatus of Schwalbe".
In mediolateral episiotomy levator ani muscle is
usually spared as that muscle supports pelvic
floor.
All muscles of anterior group of thigh are
innervated by femoral Nerve (L2,3,4)
Pubofemoral ligament resists excess
abduction. .
Hip joint is Least Stable in flexed posture.
Knee joint is Largest and most complex joint of
body.
Its highest stability is achieved in full extension.
Medial meniscus injury is more common that
lateral meniscus injury.
Medial meniscus is semilunar in shape whereas
lateral meniscus is nearly circular.
Phylongenetically Medical collateral ligament is
the degenerated tendon of adductor magnur
Phylogenetically, lateral collateral ligament is
the degenerated tendon of Peroneus longus.
Oblique popliteal ligament is a lateral extension
of semimembranous tendon.
Cruciate ligamens give anteroposterior stability
to the knee joint.
Collateral ligaments give side to side stability.

Locking of knee occurs by Medial Rotation of lower and of


femur on tibia during terminal stages of extension, when
feet are supporting the body weight.
Popliteus muscle pierces capsular ligament of
knee posteriorly to become an intracapsular
structure.
Main role of menisci of knee joint is rotational
movement.
Nerve roots involved in knee jerk reflex is
L2,3,4.
Extensor of knee is Quadriceps muscles.
Flexor of knee is Hamstring muscles.
Main joint of lateral longitudinal arch is
calcaneocuboid.
Posterior transverse arch is an incomplete arch
and formed by major parts of tarsus and
metatarsus.
Main invertor of foot is Tibialis Anterior.
Wharton's jelly is Mesenchyme of umbilical
cord.
Mullerian tubercle is elevated region in relation
to urogenital sinus at the point of contact of
uterovaginal canal.
Copula of His is Hypobranchial eminence.
Gartner's duct is persistant mesonephric duct in
female.
Para urethral glands of Skene are Urethral
glands arising from urogenital sinus in female.
Duct of Cuvier is common cardinal vein.
Blood islands of Pander is mesenchymal congregations on
the wall of yolk sac giving raise to blood cells and blood
vessels.

Liver is the largest gland of the body


Blood How through kidney 1700 L/day out of whic 170L of
glomerular filtrate is formed and only about 1.5 L wine is
formed.
Fold of Douglas or linea semicircularis or arcuate line is
related to internal oblique muscle in abdomen.
Corpora amylaceae are Prostatic concretions.
Zona pellucida is amorphous material
surrounding ovum.
Cords of Bilroth are Pulp cords of spleen.
Malpighian bodies are Nodules of white pulp of
spleen.
Hassel's corpuscles rounded bodies in medulla
due to degenerative thymic epithelial cells.
Serous demilunes of Heidenhein are Serous
alveoli capping the mucous alveoli in mixed
gland.
Cells of Paneth are cells present at the bottom
of crypt of small intestine.
Henle's loop is Part of nephron.
Leydig cells are interstitial cells present in
stroma between semiinferous tubules of testis
Sertoli cells are supporting cells in semiinferous
tubule.
Herring bodies are Neurosecretory material
seen in pars nervosa of pituitary.
Canal of Schlemm is Canal present at the sclero
corneal angle in scleral furrow.
Betz cells are large pyramidal cells located in
inner pyramidal layer of cerebral cortex.
Outer and Inner bands of Ballarger are Horizontally
running fibres located in 4th and 5th lamina of cerebral
cortex.

Node of Ranvier is Region on the nerve fibres between


two internodes.
Nissl granules are Chromatic bodies (granules) in the
cytoplasm of neurones.
Region at the junction of 3 hepatic lobules presents portal
triad, which includes a portal venous radicle, branch of
hepatic artery and biliary canaliculus.
Lung : Lining epithelium of alveoli shows the following cells
:
Type I alveolor cells Squamous cells.
Type II alveolar cells Irregular cuboidal cells (Surfactant
cells)
Clara cells Cuboidal non ciliated

Remnants
Remnant of ductus arteriosum is Ligamentum
arteriosum.
Ductus venosum Ligamentum venosum.
Urachus Median umbilical ligament.
Left umbilical vein Ligamentum teres of liver.
Right umbilical vein Disappears.
Vitello-intestinal duct Meckel's diverticulum.
Distal part of umbilical artery Medial umbilical ligament.
Proximal part of umbilical artery Superior vesical artery.
Wolfian duct Gartner duct (Gives rise to vaginal cyst).
Wolfian tubule Paraoophoron, Eoophron.
Left anterior cardinal vein Oblique vein of Marshall.

Kerking's centre is ossification centre appearing in


posterior margin of foramen magnum in occipital bones.
Haversian canal is longitudinal channel containing blood
vessel located in compact bone.
Volkmann's canal is transverse channels running from
periosteum to endosteum of bone, inter connect Haversian
canals and contain blood vessles.
Whitnall's tubercle is tubercle on orbital surface of
zygomatic bone.
Bones located add leverage to tendons and differ from
regular bones in not having a periosteum.
Bones located within the tendons are seasamoid bones.
Sesamoid bones add leverage to tendons and differ from
regular bones in not having a periosteum.
Bones ossified in a mesenchymatous membrane are
membrane bones.

Pancreatic islets are more abundant in the tail of the


pancreas and contain a cells which secrete glucogen; P
cells which secrete insulin; y cells secrete somatostatin
which inhibits secretory activity of beta or more a alpha
cells.
GEP (Gastro Entero Pancreatic) endocrine system belongs
to APUD cell series and has scattered solitary hormone
producing cells in gastrointestinal mucosa and pancreas.
Lamina propria of the intestine is the chief site for
production of the secretory immunoglobulin (IgA).
Secreted IgA coats the mucosal surface and prevents the
attachment of the antigen to the intestinal cells. IgA is
important for local immunological process through out the
body.
Villi are absent over the Payer's patches.
Epithelium covering the Payer's patches has "M" cells
which help in immune responses.
Lining of terminal bronchioles is simple columnar or
cuboidal epthelium with or without cilia but without
mucous glands or goblet cells in the wall.
Interalveolar septum in between the alveoli is composed of
lining cells of adjacent alveoli and structures interposed
between them (capillaries).
Inverted retina is characteristic of all vertebrates.
Ora serrata is the scalloped anterior margin of neural
retina.
Midler's cells are retinal neuroglial cells.
Unicellular mucous gland is goblet cell.
Striated ducts of the salivary glands modify the
composition of alveolar secretions.
3 cells of the islets comprise 60-90% of all the islets cells.
They are in the central part, a cells are located in
peripheral part.
Terminal bronchioles are the finer divisions of conducting
part of respiratory system which are 0.5 mm or less in
diameter.
Sertoli cells of the testis produce steroids, secrete fluids
including androgen binding protein, inhibin in adult and
Mullerian inhibiting hormone in the fetus and estrogens.
Sternal angle is also called angle of Louis (5 cm below
suprasternal notch.
Foramen of Morgagni (in duaphragm) is also called
Larry's space.
One type of entero endocrine cell may become numerous
and produce carcinoid tumour, characterised by excessive
secretion of serotonin.
Premature infants suffer with respiratory distress
syndrome due to lack of type II pneumocytes in lungs.
Talus is the key stone of the arch. It receives body weight
and transmits it to the arches below.
Body to the axis (C2) bears a strong process getting
vertically upwards from its superior surface. This process is
"odontoid process" which is the detached centrum of atlas.
Bodies of 5th to 8th thoracic vertebrae on left side show
flattening due to pressure of thoracic aorta.
Coccyx usually has 4 rudimentary vertebrae fused to single
piece.
Failure of fusion of two arch centres posteriorly results in
"spina bifida" occurs commonly in lumbar region. If the
deformity is not associated with neurological abnormality it
is "spina bifida occulta".
When the defect involves one or several arches, spinal cord
with meninges may prolapse (meningomyelocele).
Fractures of spine most commonly involve T12 LI and L2
cause is usually flexion compression type of injury.
Disc prolapse or prolapsed intervertebral disc is protrusion
of nucleus pulposus posteriorly into vertebral canal through
posterior part of annulus fibrosus either due to trauma or
degenerative changes in the annulus. Most common sites
are L4L5 or L5/ SI.
Prolapse of L5/S1 disc produces pressure on 1st sacral
nerve.
Plane of greatest pelvic dimensions is at the level of pelvis
where the cavity is most spacious. It's antero posterior
diameters taken from a point between 2nd & 3rd sacral
vertebrae and middle of symphysis. Children under 9 years
and males have anthropoid type of pelvis (dolichopelvic).

Abrupt pronation during tennis play causes sprain or


partial tear of radial collateral ligament. This is manifested
as pain tenderness over lateral epicondyle.
Tennis elbow is a condition which has either sprain of
lateral ligament of elbow joint or tear of some fibers of
extensor radialis brevis or an inflammation of its bursa.
Lumbar triangle of Petit is triangular area bounded by
Latissimus dorsi, iliac crest and external oblique.
arcuate ligament is a poorly defined arch in front of aorta
connecting the medial tendinous Median margins of crura
of diaphragm.
Medial arcuate ligament is the tendinous arch in fascia
covering the psoas major muscle.
Lateral arcuate ligament is the tendinous arch in anterior
layer of thoraco-lumbar fascia covering Quadratus
lumborum muscle.
Biceps brachii is a flexor of elbow and a powerful
supinator of forearm when the arm is semiflexed.
Brachioradialis is flexor of elbow when the forearm is in
mid prone position.
Lumbrical muscle tendon in hand turns round the lateral
sides of fingers, but in foot they turn round the medial
sides of to reach the dorsal digital expansions.
Motor supply to skeletal muscles is through spinal or
cranial nerves, but to cardiac and smooth muscles it is
through autonomic nerves.
All the muscles of mastication are supplied by mandibular
division of trigeminal nerve (V Cranial).
All anterior crural muscles are supplied by deep peroneal
nerve..
Posterior crural muscles are all supplied by tibial nerve.
A muscle which initiates and maintains a movement is a
prime mover.
A muscle which can initiate and maintain an opposite
movement of the prime mover is antogonist.
A muscle which can eliminate the additional unwanted
movements produced by a prime move at a joint other
than the desired joint is called a synergic muscle.
Muscles of head can be grouped into muscles of facial
expression and muscles of mastication.
Trumpeter's muscle is buccinator.
In quiet inspiration, the thoraco-abdominal diaphragm is
the sole muscle concerned with movements.

Triangle of auscultationa space bounded by trapezius,


latissimus dorsi and medial border of scapula. Deep to this
triangle, cardiac orifice of stomach lies (on left side). (1) In
oesophageal obstruction s splash of swallowed liquied can
be ausculated in the region of left side. (2) Apex of lower
lobe of both lungs is located beneath this area of
corresponding sides.
Torticollis is deformity due to contracture of
sternocleidomastoid muscle.
Paralysis of gluteus medius and minimus produces lurching
gait.
Triangle of Koch is area on where AV node is located in
right atrium.
Annulus of Vieussen's is Arterial circle formed by right and
left conus arteries at the commencement of pulmonary
trunk.
Recurrent artery is central branch arising from anterior
cerebral artery.
Rateson's plexus is internal vertebral venous plexus.
"Moderator band" runs in septomarginal trabecul to
anterior papillary muscle.
On the left aspect of Interatrial septum "Lunate
impression" is the representative of osteum secundum.
Superior thyroid artery is related to external laryngeal
nerve. Nerve lies frequently on a more posterior plane.
Superior laryngeal artery which is in close relation with
internal laryngeal nerve is a branch of superior thyroid
artery.
Axillary artery is the continuation of subclavian artery at
the outer border of 1st rib.
Arteria princeps pollicis is a branch of radial artery. It turns
medially into palm and supplied nutrient artery to 1 st
metacarpal bone.
Arteria radialis indicis frequently arises from arteria
princeps pollicis.
"Thoracic Aorta commenses at lower border of T4 and
terminates at lower border of T12 (aortic opening of
diaphragm) and continues beyond that level as abdominal
aorta upto L4 vertebra. Here it divides into two common
iliac arteries.
Supraduodenal artery is a branch either from
gastroduodenal or hepatic vessels.
Gastroduodenal artery is a brach of hepatic and divides
into superior pancreatico duodenal (supplies pancreas &
duodenum) & right gastroepiploic arteries.
Gastro epiploic vessles run in greater omentum along the
greater curvature of stomach.
Coeiiac artery supplies lower part of oesophagus, stomach,
1 st and upper half of 2nd part of duodenum.
Profunda femoris artery gives lateral and medial circumflex
femoral and four perforating arteries.
Femoral artery runs in adductor canal (subsartorial canal)
and becomes popliteal artery at the level of adductor
opening.

Coronary sinus opens into right atrium and guarded by a


valve; tributatries are great cardiac vein, small cardiac
vein,middle cardiac vein, posterior vein of left ventricle and
oblique vein of left atrium.
Superior vena cava drains upper limbs, head, neck and
thorax into posterior part of right atrium.
Veins draining the face:Angular, Facial maxillary, Middle
temporal
Tributaries of Internal Jugular vein are :Veins of tongue,
Veins of pharynx, Veins of thyroid, Veins of face (through
facial vein), Inferior petrosal sinus
Right coronary artery supplies conducing system of heart
as far as proximal parts of the right and left bundle branch.
SA node is supplied by right coronary artery (artery to SA
node or nodal artery).
AV node is supplied by right coronary artery (branch of
large posterior septal artery, a branch of posterior
interventricular branch of right coronary artery).
Posterior interventricular artery is a branch of right
coronary given at the crux of heart.
Anterior interventricular artery is a branch of left coronary
artery.
"Circle of willis" is formed by posterior cerebral, middle
cerebral, anterior cerebral, posterior communicating
arteries and is located in inter peduncular fossa of base of
brain.
Tonsillar artery is a branch of facial artery.
Middle meningeal artery is a branch of maxillary.
"Anastomosis around the elbow" is between superior and
inferior ulnar collateral, descending branches of profunc
brachi, ulnar recurrent, radial recurrent, and interosseous
recurrent arteries.
Arteries taking part in "anastomoses around the knee
joint" are medial & lateral genicular arteries, descending
genicular artery, descending branch of lateral circumflex
femoral, circumflex; fibular, anterior and posterior tibial
recurrent artery.
"Cruciate anastomoses" is formed by 1st perforating
branch of profunda femoris, branch of inferior gluteal,
branch medial and lateral circumflex femoral vessels.
Trochanteric anastomosis is formed by branches of
superior gluteal artery, ascending branch of lateral
circumflex and deep circumflex iliac artery.
Emissary veins connect the intercranial venous sinuses
with extracranial veins.
Cavernous sinus contains internal carotid artery, III, IV, VI
and maxillary division of V cranial nerves in its walls wide
communication with veins outside the skull.
Sigmoid sinus is in close relation to mastoid antrum.

Great cerebral vein opens into straight sinus.


Basivertebral veins drain the bodies of vertebrae.
In fetus, internal iliac artery is twice as large as external
iliac artery.
1st part of superior vesical artery is the proximal patent
section of umbilical artery.
Superior and middle thyroid veins open into internal
jugular vein and Inferior thyroid veins into brachiocephalic
of corresponding sides.
Shadow of left profile of aortic arch in X-ray photographs is
called "aortic knuckle".
In wounds of Palmar arches, ligature of vessels proximal to
wrist may be inefffective as there is anastomoses between
radial and ulnar arteries through their palmar and dorsal
carpal branches and other branches.
There is constant anastomosis between branches of last
sigmoidal and superior rectal arteries "Critical point of
Sudack" is non anastomatic area on sigmoid colon when
the above anastomosis is absent.
Facial vein has communications with cavernous venous
sinus, hence infective thrombosis of facial vein may extend
to the intracranial venous sinuses.
In thrombosis of superior bulb of internal jugular vein IX,
X, & XI nerves are involved.
Cannulation of basilic vein is more liable to be successful
than cephalic as the basilic vein continues as axillary vein
without angulation.
Axillary vein thrombosis in prolonged abduction (Eg.
Painting a ceiling) may be due to the groove produced by
subclavius muscle on the 1st part of vein where there is a
valve in the wall.
Obstruction of portal vein may produce opening of sites of
portocaval anastomoses which are at:
Lower end of oesophagus leads to oesophageal
varices. (Communication between left gastric & azygos
system of veins).
Umbilicus-caput medusaedue to opening up of para
umbilical veins
Lower end of rectum & anal canal communication
between
The Schwann cells form the neruolemma and myelin
sheath of nerve fibres in the peripheral nervous system
whereas oligodendrocytes form myelin around nerve fibres
in the CNS

Peculiarities of clavicle are :-


This is the only long bone that lies horizontally in the
body
It is the first time to ossify in the body
It is the only long bone which ossifies from two primary
centres
It has no medullary cavity
Occasionally, it is pierced by middle supraclavicular nerve

The largest cerebellar efferent bundle is the superior


cerebellar peduncle. This is formed by fibres from the
globose, emboliform and dentate nuclei.
Mundinus or Mondino d' Luzzi is called the Restorer of
Anatomy
Leonardo da vinci of Italy is called the 'Originator of.cross
sectional anatomy
Vesalius is called the 'reformer' of anatomy
William Harvey discovered circulation of blood
William Hunter introduced present day embalming
Raphe is defined as a fibrous band made up of interdigiting
fibres of tendons or aponeuroses.
According to Wolff's law, the bone formation is directly
proportional to stress and strain
Motor point is the site where the motor nerve enters the
muscle
Glioblasts are stem cells that differentiate into microglial
cells
The mucous membrane of jejunum contains tongue shaped
villi
Blood brain barrier is constituted by capillary endothelium
(with fenestrations), basement membrane of endothelium
end feet of astrocytes covering the capillary walls.

Carpal Tunnel and its contents


It is osseofibrous tunnel between concave palmar suface of
carpal bones and deep surface of flexor retinaculum of
wrist Contents
1.Four Tendons of Flexor Digitorum Superficialis
2.Four Tendons of Flexor Digtorum Profundus These 8
tendons are enclosed in a common synovial sheath (Ulnar
Bursa)
3.Median Nerve
4.Tendon of Flexor Pollicis Longus enclosed in a synovial
sheath (Radial Bursa)
Tendon of Flexor Carpi Radialis with its synovial Sheath

Cribriform Fascia is pierced by the following structures.


1.Great Saphenous Vein
2.Superficial branches of Femoral Artery
(a)Superficial External Pudendal Artery
(b)Superficial Epigastric Artery
(c)Superficial Circumflexiliac artery
3.Lymph Vessels connecting superficial and deep inguinal
lymph nodes

Neck pulsation felt inferiorly at medial border of


sternocleidomastoid is Subclavian
Mandibular nerve lesions at orign involves following Tensor
Palati, Messeter and Tensor Tympani
Pyramidal fibers are projection fibers
Trigeminal nerve extends lower down up to the level of C2
Safety muscle of tongus is Genioglossus
The choroid plexus of the fourth ventricle is supplied by the
posterior inferior cerebellar artery
Unpaired artery in the brain is basilar artery
Arch of aorta begins opposite 2nd costal cartilage
The largest group of axillary lymph nodes is apical.
The most important component of the development of
diaphragm is septum transverum
Triangle of Koch is bounded by tricuspid leaflet, orifice of
coronary sinus & tendon of todaro
Diaphragm is at lowest level in prone position
Structure affected first when accessory cervical rib is
stretched is medial cord of brachial plexus
Phrenic nerve lies in middle and superior mediastinum
Transverse arch of foot is maintained by abductor hallucis
brevis.
A fontanelle occasionally occurring in the sagittal suture is
Casser's fontanelle.
Wrisberg's nerve is Nervus intermedius.
Dawbarn's sign : In subacromial bursitis pressure over the
deltoid below the acromion (with the arm by the side)
causes pain.
However when the arm is abducted pressure over the
same point causes no pain, because bursa disappears
under acromion is called Dawbarn's sign.

End Arteries
Artereis which do not anastomose with their adjacent one
are called end arteries. e.g.
(i) The best example being central artery of retina.
(ii) Central branches of central arteries.
(iii) Vasa recta of mesenteric arteries.
(iv) Arteries of spleen, kidney, and metaphysis of long
bones.

Left coronary artery


Branches
Ant. interventricular branch.
Circumflex branch.
Distribution
Rt. auricle in 40% of cases.
SA node in 40% of cases.
AV node and Bundle of His in 10% of cases.
Large part of left ventricle.
Upper margin of the ant. surface of right ventricle.
Post, surface & the auricular appendage of the left
atrium.
Note : Branches of both Rt. & Lt. coronary arteries
supply interatrial and interventricular septa.

Tributaries of the coronary sinus


Great cardiac vein ' Oblique vein of the Lt. atrium.
Small cardial vein. Post, vein of the Lt. ventricle.
Middle cardiac vein.

ABDOMEN
IMPORTANT RELATIONS
Relations of bile duct
A.Supraduodenal part (in the free margin of lesser
omentum)
1. Anteriorly : liver 2. Posteriorly : portal vein and
epiploic foramen.
3. To the left: hepatic artery.

B.Retroduodenal part
1. Anteriorly : first part of duodenum 2. Posteriorly :
inferior vena cava
3. To the left: gastroduodental artery
C. Infraduodenal part
1. Anteriorly : a groove in the upper and lateral parts of
the posterior surface of the head of the pancreas.
2. Posteriorly : inferior vena cava. 3. Relations of the
Kidneys

A. Relations Common to the Two Kidneys


1.The upper pole of each kidney is related to the
corresponding suprarenal gland. The lower poles lie about
one inch to the iliac crests.
2.The medial border of each kidney is related to (i) the
suprarenal gland, above the hilus; and (ii) to the ureter
below hilus.
3. Posterior relations .
The posterior surfaeces of both kidneys are related to : (1)
the diaphragm; (2) the medial and lateral arcuate
ligaments; (3) the psoas major; (4) the quadratus
lumborum; (5) the transversus abdominis; (6) the
subcostal vessels; and (7) the subcostal, iliohypogastric
and ilioinguinal nerves. In addition, the right kidney is
related to 12th rib, and the left kidney to 1 lth and 12th
ribs.

B.Other Relations of the Right Kidney


1.Anterior relations:
1.Right suparental gland; (2) liver; (3) second part of
duodenum; (4) hepatic flexure of colon and (5) small
intestine. Out of these the hepatic and intestinal surfaces
are covered by peritoneum.
2.The lateral border of the right kidney is related to the
right lobe of the liver and to the hepatic flexure of the
colon.
C.Other Relations of the Left Kidney
1.Anterior relations :
1.left suprarenal gland; (2) spleen; (3) stomach; (4)
pancreas; (5) splenic vessels; (6) splenic flexure and
descending colon; and (7) jejunum. Out of these the
gastric, splenic and jejunal surfaces are covered by
perotoneum.
2.The lateral border of the left kidney is related in the
spleen and to the descending colon.
Relations of Right Suprarenal Gland
A.The base is related to the upper pole of the right kidney.
B.The anterior surface is devoid of peritoneum, except for
a small part inferiorly. It is related to : (1) the inferior vena
cava medially; (2) the liver, laterally; and (3) occasionally
to the duodenum, inferiorly.
C.The posterior surface is related to the right crus of the
diaphragm.
D.Anterior border. A little below the apex it presents the
hilum where the suprarenal vein emerges.
E.Medial border. It is related to : (1) the right coeliac
ganglion; and (2) the right inferior phrenic artery.

Relations of Left Suprarenal Gland


A.Anterior surface. From above downwards it is related to :
(1) the cardiac end of the stomach; (2) the splenic artery;
and (3) the pancreas. The upper end may be related to the
posterior extremity of the spleen. Near the lower end there
is the hilum through which the left suprarenal vein
emerges. Only the gastric impression is covered by
peritoneum (of the lesser sac):
B.Posterior surface. It is related to : (1) the kidney,
laterally; and (2) the left crus of the diaphragm, medially.
C.Medial border. It is related to : (1) the left coeliac
ganglion; (2) the left inferior phrenic artery; and (3) the
left gastric artery.

THORAX
MEDIASTINUM AND ITS CONTENTS
Subdivisions of Mediastinum
Superior mediastinum
Locationfrom inlet of thorax to plane extending from
level of sternal angle anteriorly to lower border of T4
vertebra posteriorly
Contents
a. Muscles attached to sternum (sternothyroid and
sternohyoid)
b. Remnants of thymus gland
c. Vessels
1. Arch of aorta
2. Origin of brachiocephalic, left common carotid, and left
subclavian arteries
3. Left and right branchiocephalic veins
4. Superior vena cava
d. Trachea
e. Esophagus
f. Nerves and plexuses
1. Vagusright and left
2. Left recurrent laryngeal
3. Phrenicright and left
4. Cardiac plexus (superficial)
g. Lymphatics
1. Brachiocephalic and tracheobronchial nodes

2. Thoracic duct
Inferior mediastinumhas three subdivisions that extend
downward from lower border of superior mediastinum to
diaphragm
1. Anterior mediastinum
a. Locationposterior to body of sternum and attached
costal cartilages, anterior to heart and
pericardium
b. Contents
1. Fat
2. Remnants of thymus gland
3. Anterior mediastinal lymph nodes
2. Middle mediastinum
a. Locationbetween anterior mediastinum and posterior
mediastinum
b. Contents
1. Heart and pericardium
2. Beginning or termination of great vessels
3. Pulmonary arteries and veins
4. Phrenic nerves
5. Bifurcation of trachea
6. Tracheobronchial lymph nodes
7. Cardiac plexus (deep)

Posterior mediastinum
a. Locationposterior to heart and pericardium, anterior to
vertebrae T5-T12
b. Contents
1. Esophagus
2. Descending aorta and origins of posterior intercostal
arteries
3. Azygos system of veins and termination of posterior
intercostal veins
4. Nerves
a. Vagus nerves
b. Splanchnic nerves
5. Lymphatics
a. Thoracic duct
b. Posterior mediastinal nodes
c. Tracheobronchial nodes
d. Bronchomediastinal trunk

Boxer's muscle--Serratus anterior.


Locking muscles---Popliteus.
Casser's perforated muscle---Coracobrachialis
Coiter's muscle--Corrugator supercilli.
Cowl muscle---Trapezius.
Rider's muscle---Adductor muscles of thigh
.Laughing/Smiling muscle----Zygomaticus
major.
Sommering's muscles---Levator glandulae
thyroideae.
Theile's muscle---Superficial transverse perinei
muscle.
Toynbee's muscle----Tensor tympani.
Wilson's muscle---Sphincter urethrae.----Few
fibres of Levator ani.
Wrinkler muscles of eyebrow---Corrugator
supercilii.
Sibson's muscle---Scaleneus minimus.
Gavard's muscle---Oblique fibres in the
muscular coat of the stomach.
Oehl's muscle------Strands of muscle fibres in
the chordae tendineae of the left A-V valve.

Autonomic nervous system

Sympathetic Parasympathetic
system(thoracolumbar system(craniosacral
outflow) outflow)

C3, T11,L4 3,7,9,10 cranial


nerves.S2,3,4.

More active during Active during sleep


wakeful hours

Adrenergic cholenergic

Pupillary dilatation Pupillary constriction

Cardiac acceleration Slowing of heart rate

Spleenic contraction

Vaso constriction in skin & Vaso dilatation of skin


viscera & viscera

Coronary vasodilatation

Inhibition of intestinal Increasing peristalsis


motility

Broncho dilatation Bronchial constriction

Ejaculation of semen Penile erection


Contraction of sphincter Contraction of urinary
bladder

Hepato gluconeogenesis Increased secretion of


insulin

Glycogenolysis Edinger westphal


nucleus, lacrimatory
nucleus, superior
salivatory nucleus,
inferior salivatory
nucleus, dorsal nucleus
of the vagus.

Ciliary ganglion,
pterygopalatine
ganglion,oticganglion,
submandibular ganglion.